Multifocal IOLs and Halos

[Richard123]

With regard to the multifocal IOLs, such as Restor and Rezoom, I am trying to determine what is meant by the nighttime haloing effect that is reported by some on this forum. Also the accommodating IOL, Crystalens, does it have the same or similar effect?
I have found a website that has simulations of various visual conditions including halos and starbursts. This is the address:
http://www.visionsimulations.com/
A question to those of you who have a multifocal or accommodating IOL and are experiencing night vision problems:
Is the simulation at the above site accurate or are you seeing something other than what is depicted there?
Any information about this would be appreciated.
Thanks
Richard

[K-D]

Hi Votglo,
I really do not know why you have a suture. I am sure someone with opthamology knowledge will answer that for you. I know that before the procedure that they genereally  do now, sutures were always used.  My parents had sutures.  I did not have a suture.  But I am sure there was a reason why the doc thought it would be best in your case.  Each eye is different.  I believe I could have laser to try and reduce the halos but I just do not want to take the change of changing the clear vision that I now have.  Trade offs is the word.  I still have slight edge reflection of the implant that seems to be getting less.  And I have slight glare which is removed by moving my head.  That also seems to be decreasing. (All in dark only) .  But as for the halos, well guess that is the price I have to pay for wanting to put on my mascara without glasses.  ;-)

[votglo]

Hi Kathy!
After reading this thread, the description of your halos is exactly the same as what
I am seeing.....it' good to know that is more common w/astigmatism......I think that using
a contact in my right eye helps this condition and also acceptance of the "trade offs"
w/Rezooms vs. other multi-focals.
Did your Dr. talk about trying to correct the astigmatism?  I dont remember how
severe mine is.....I think alot......the same question I asked in another thread is
about the suture that is still in my eye......that must be related to astigmatism....
did you have a suture?

[LuvMK]

I have ReZoom implants in both eyes.  3 weeks out on the left and 2 weeks out on the right.  My far vision is very good but my near vision is not very good at all.  I've been told that the near vision will come in with time, that it can take anywhere from 6-12 weeks for the brain to reprogram itself and get to the best vision.  Just curious if any others with Rezoom can share their experience with the healing time and how soon their near vision was good.

[hud]

Not that I know of. Typically patients with large pupils report early edge glare with all types of implants, so you might expect some of that with whichever lens you and your doctor choose.I'm not sure what you mean by trouble with sunlight, but if you're like me, you've always been more comfortable wearing sunglasses in bright sun for comfort.

[songez]

Hud,
You are the best. I will go with the Restor lens and let you know how it works. Only one last thing, for now, I probably have large pupils (trouble with sunlight since my teens). Would this in anyway be a counterindication for the Restor lens?
Thanks,
s.

[hud]

I'm sorry. I get a train of thought going, and it misses the station. Alcon makes the Restor lens. Advanced Medical Optics (AMO) makes the Rezoom and Tecnis brands. I meant to say that AMO is stuck with the old technology of full-optic diffraction since they are into the final stages of the FDA studies of the Tecnis Multifocal. It will have a 4 diopter add like ReSTOR, but it is not apodized, and the diffractive rings go all the way to the edge of the optic, just like the 3M design from the 1980's. Alcon's Restor design is much more refined with nanotechnology applied to the apodized diffractive rings, and they are limited to only the central half of the optic. These refinements have minimized the unwanted visual effects seen with full optic diffractives.
Also, when you pick up something to see close, everyone, young and old, has a pupillary constriction response. Restor is physiologic in this way , giving near and far focus in medium to small pupil scenarios. But when the pupil enlarges, a gradual blending of the focal points occurs, shifting a higher proportion of light energy to the distance focus. This helps as you bump around your bedroom at night. I hope that helps.

[songez]

Hud, Thanks for taking the time and explaining so much. However, due to my ignorance, there is something that I don't understand. You say, "They are stuck with this old technology as they are far along the FDA approval path." To whom are you referring? And, is this "old technology" the Restor lens? Thanks.

[hud]

The Tecnis multifocal will not be availble in the US for a year or two. You could go to Europe to have it now, or have a ReSTOR implant today.
I say this because the Tecnis multifocal is built on the same 1st generation diffractive optic that 3m developed in the 1980's. The 3M design was a full-optic diffractive surface with 3.5D add. The 3M studies showed a 59% spectacle-freedom rate. Alcon bought 3M VisionCare for this technology, and refined it by apodizing the diffractive component, and limiting the diffractive portion to the center of the optic and bumping the add to 4D. The latter two modifications has improved the specatacle-freedom result to 90%, while reducing the unwanted visual aberrations. Alcon patented these changes, and then released the rights to full-optic diffractive implants. Pfizer/Pharmacia acquired that technology to get in the game, and then Pfizer dumped Pharmacia's eye business to AMO. They are stuck with this old technology as they are far along the FDA approval path. The only modifications that Tecnis made to the 3M design is they bumped the add to 4D (like ReSTOR), and made the optic aspheric (which will give a small incremental benefit with large pupils).

[JodieJ]

The Tecnis multifocal is not expected to get FDA approval until late '07 or early '08.  It's supposed to provide excellent distance and near vision, but maybe less than excellent intermediate vision.  From what I've read, contrast sensitivity/night vision is supposed to be better than with other multifocals, but glare/halos may still be a problem.

If you're interested in this lens, you can find out more by using any of the search engines.

[songez]

does anyone have any experience with the new Tecnis Multifocal IOL? I read for many hours per day and therefore would love to have near vision to eliminate the need for glasses. My understanding is that this IOL reduces the glare and halo problems of earlier multifocal lenses. In additional, given my failure with monovision with contacts, I am not a candidate for different monofocus in each eye. Thanks.

[K-D]

Hi Don,

Seems like the bottom line is that for people that want reading over computor, Restor is the choice.  And Computor( intermediate) over reading, Rezoom seems to be the one. And then there is the Crystalens, which has advantages also. That is why it is so important for the doctor to listen to the patient's priorities.  There are tradeoffs with IOL presently.  In the future, I am sure there will not be.  Still how fortunate that we have the choices that we do.  It sure beats the old coke bottle glasses that people had to wear in the past.

[JodieJ]

Congratulations on your fantastic results with your first ReStor lens!  And I'm sure it will get even better after your second implant.  It's nice to know that the right patient (healthy eyes, no astigmatism) and a skilled surgeon can produce such good vision with multifocals.  After reading this forum for awhile, it seems like many (most?) of the worst results are from patients who weren't good candidates for multifocals at the onset (and perhaps surgeons still on the learning curve.)

[Don B]

Hi to all...first post after reading this great forum for a while. Want to give back what little info i have at this time for the benifit of all. Had rezoom in left eye 7/20 and first post op yesterday. My vision before surgery was not bad,20/70 distance, could see pretty go distsnce but couldn't read without progressives. But cateract in left eye was getting worse and it was time or so i thought. I am a male,70, in excellent health. The doctor i used does all three types but said he gets best result with Rezoom and recommended it only based on past experience not what was best for me  I researched the benifits of all types as best i could and went along with his recommendation(fat,dumb and hoping for the best). i did give Restor a good look though and probably would have gone with it but for the Doc's recommendation. We did discuss what I expected which was to see computer screen with no glasses and hopefully read a magazine too, wanted no glasses.
I see distance and intermedite very good, I can read computer screen at 24 in very well. I can't read mag or paper at normal distance. I see halos at night only so far and not so bad. i see a shadow at outer corner of eye...like an arc which i thought was outer edge of lens but he says its reflection and not outer edge. Its not bad and i can get used to it. Viewing has not changed at all since surgery. Distance now at 20/30 and close  about the same. He says viewing close will probably get better when other eye is done 8/2...we will see. So far the worst is that I need readers to read...I was hoping to not need them. I guess I am fortunate as compared to others who have had trouble . No complaints and will use Rezoom in other eye. Hope this helps someone.

[LLGirl]

HI everyone,  got Retor implanted in my left eye two days ago, and am having really good luck.  Yesterday at my doctor appt, with my other eye covered, i had 20/20 on distance, and J1 for the near - 1 day post op.  I was so amazed that i could actually read all of the lines on both charts!  I used to really struggle to read to about the middle lines with my contacts in!  I was wearing a contact in my right eye, but it was hard to see well iwth both eyes competing, so at my appt the doctor told me to not wear a contact in my right eye, and let my new eye get used to being the one i see more with for the next week.  The surgery for my ohter eye is 8/2, so it won't be long to wait.  I can see distance to drive or watch TV perfectly with just the REstor eye.  REading is a bit harder, since i am nearsighted and my fuzzy eye messes me up a little, but if i close my fuzzy eye, i can see well with the REstor eye for near.  Computer is a bit fuzzy, but not as bad as i expected.  The near vision with Retor was not as close as i was worried it might be - it is at a comfprtable, normal reading distance, for me anyway (since i was previosuly near sighted).   I can't believe how well i am seeing already, after two days (i did not have any astigmatism to correct), and i am very excited to get the 2nd eye finished so that i can see really well with no glssses!

[hud]

great info- who are these surgeons going to consult with Alcon, that I may speak with them? I do appreciate the heads-up.

[Eagle eyes]

ReZoom has not been available for years, only since last year, one month after ReSTOR. ReZoom is different than Array. The Array was silicone and is discontinued. Both ReZoom is and Array was a refractive optical IOL. More near vision is devoted for smaller pupils with ReZoom than Array. Less near vision is devoted to larger pupils with ReZoom than Array and more to distance to give less halos with ReZoom than Array.

Yes to huds point--> There are halos with both ReSTOR and Rezoom. However, the halos have nothing to do with the add power in the lens. It has to do with the continous optical system of a refractive optic.It is not harder for the brain to defocus a ReZoom vs ReSTOR halo. It depends on other factors and yes, comparitively speaking our patients that have ReSTOR in one eye and ReZoom in the other eye do notice a difference in the halo. They also notice sustainable differences in how each eye functions independently of the other. That is exactly why more and more patietns are getting the mixing of these premium IOLs or blended vision.

AMO is making a 4 diopter add diffractive optic "Tecnis multifocal". It has been in the works before ReSTOR was approved. It has already been available in Europe for a year.

Alcon, the maker of ReSTOR is making a +2.50 add ReSTOR because fewer docs are using ReSTOR now as the intermediate vision is a problem which was first noticed last year, and then the waxy distance vision issue came up. Over the past 4 months or so this waxy distance vision has been the catalyst to make the blended vision phenomenon accelerate. At first, Alcon said that only the AMO doctors were doing this. Now as Alcon investigators and loyalists have stepped upm uch to Alcon's shock and said this is the real deal, Alcon is making it's own changes. Alcon is planning to offer blended vision with their current ReSTOR and the new ReSTOR. It is a bifocal system so that is why there is a "start and stop" in the visual system. The near vision is fantastic. The intermediate vision slows down or stops. The distance varies from patient to patient. This means there is validity to blended vision.

The continuous vision of the refractive true multifocal optic ReZoom provides the near (not as strong as ReSTOR), better intermediate than ReSTOR, and excellent distance vision because of the refractive distance dominant center.

The blended vision thing is a curiousity for the surgeons that have not tried it, but more and more have and once they do, they see the success.  

I agree folks, do not make your decisions on these anecdotes, but experience is a great teacher for us all. Keep a diary of your tasks, activities, and your desires then have your surgeon check your pupil size in bright and dim light, as well as a thorough eye exam and together the two of you make your choices of ALL viable options.

Since hud says he is a financial guy and not an Alcon employee then he may not know that some of my colleagues (other employees of eye surgeons) that teach courses for both AMO and Alcon are being flown into Alcon headquarters to have a week long meeting on blended vision this month. Mixing and matching IOLs as well as the explanation of the new ReSTOR with lower add coming out.

This is why it is best to go to someone in your area that keeps up with the latest info because it changes constantly. All of these IOLs work well if you know which one is the best fit for you.

[LouCat]

Hello group....I have a comment.   I had one eye RESTOR on
6-21-06.   So far no clear vision and the starburst & halos are
so severe, I absolutely could not drive at night.  Have done it
  on familiar streets...4 X.     I  am concerned as my other
  eye is 20/400....legally blind, and I am wondering if I could
  count on Healing with time.  I can be happy to wait 6 months
  if I-DO-GET-BETTER.     Comment for the subject.

[LLGirl]

I think i am going to stick with Restor.   Hud, you have the near vision up to about 15 inches, and the distance... the intermediate, like washing dishes, etc., is it just a little fuzzy or ??  Not enough to bother you though?

[hud]

Rezoom has been virtually available for years as the Array lens. The Array was the silicone version with more refractive optic devoted to near vision than its acrylic replacement, Rezoom. This has helped with reducing the unwanted imaging of Array, but its a trade-off. There are halos with both ReSTOR and Rezoom, but they are definately more persistent with Rezoom as it has just a 3.5 diopter-add, which is harder for the brain to defocus. The company that makes Rezoom is trying to get out a 4 diopter-add diffractive optic multifocal (Tecnis) to match the performance of the 4 diopter add diffractive Restor. The blended vision thing is a curiousity for most surgeons now, and will not become mainstream until one technology (refractive, diffractive, or accomodative) can do it all with consistency. Please don't make your decision from any anecdote. Your eyes are like your fingerprints, you and your surgeon should decide how to treat them.

[eyecu]

My father and uncle have had Array lenses implanted which was the first multifocal lens. They are very happy. The surgeon who did that surgery uses the ReZoom now as his lens of choice so I know more people who have that lens implanted. I am sure there are very many happy ReStor patients as well. But you have to look at the optical system. The ReZoom provides better intermediate vision and clearer distance vision across the board. The Restor offers stronger or more consistent near. But my dad has the Array and can read without glasses and is happy so he is fine with his near. You get the halo effect with both. SO it boils down to what you do and what your work is etc. If the ReStor had worked so well, then blended vision would have never come about in the first place because there would have been no need for it. Obvioulsy patients were not happy. I have a friend whose father in law got the restor and was not happy with his first eye. After about 2 months he had the ReZoom put in the other eye and is very happy as they both work together to give him what he was looking for.More surgeons are now trying the ReZoom and you will start to hear more about it due to that fact. The market has recognized it as well.

[LLGirl]

Wasn't it march of 2005 that both Restor and Rezoom was approved?

[LLGirl]

But i thought that Restor and Rezoom came out into the market about the same time, only about a year ago?

[LLGirl]

You speak of knowing many that have had multifocals implanted and are happy.  YOu specifically mention the Rezoom, but do you also know many satisfied with Restor lenses implanted?  I am having those put in left eye on 7/19, right eye 8/2.  Just wondering - doesn't seem like as many people choose it, or maybe not as many with Restor are having problems, and aren't writing in to these forums?

[K-D]

Richard, when in a theater, the screen is very clear.  The lights in the theater on the side of the screen, next to an aisle, have circles around them.
In a restaurant, I see circles around candles or lights.  But reading the menu is great in low lightening.  All about trade offs I guess.  Hope I answered your question.