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

[Forum-OD-MP]

interesting site.

YES the halos depicted there are approx what most people complaining of "halos" see.  similar, anyway.

all multifocal IOL's can cause halos.  IMO crystallens is no better than restor or rezoom in that regard.

[Richard123]

Thanks. I had been picturing something completely different when I read about the haloing. I was not picturing an amorphous sphere of light as depicted on that site, but a ring of light around the light source, like an angels halo.
Maybe even multiple rings corresponding to the rings of the multifocal IOL.
If this kind of "sphere" haloing is just as common with the crystalens then I guess that would also apply to the regular monofocal lenses?
I wonder about the monofocal ones because I have also been considering monovision using the regular monofocal IOLs (combining far for the dominant eye with middle for the nondominant eye and using reading glasses for near).

[Ag-i-doc]

monofocal lenses are much LESS likely to cause halos b/c of the way their optics are made.  very few monofocal IOL patients complain of halos.

[Richard123]

I am confused then.
I thought the crystalens was just a monofocal that could move, to a limited degree, in response to the cilliary muscle.
I thought that would mean it would have the same glare and halo characteristics as a fixed monofocal.
But are the optics of the lens also different resulting in more glare and halo problems than a monofocal lens?
Thank you very much for your responses, this is helping me a lot.

[K-D]

Hi Richard,

Speaking for myself, and I have astigmatism, I do see the halos shown like those at the website that you have provided.  I do not know if other people see what I do, but I will try to give you a understanding of what I see with the multifocal lens,( at night only.)  If the light source is horizontal, I get the soft halo effect.  However, if the light source is vertical, I get large circles around the light source with spokes in them.  I do not know if people that do not have astigmatism see this as I do.   The circles are more annoying to me than the halos.  However, I have adjusted to them, (for the most part), and am hoping they will decrease when I have my other eye done. I feel that for me, the advantages outweigh the lively night show.  But I do not do much night driving. And everyone is different. And what is right for one person, may not be right for another. And what one person sees at night, may not be what another sees. Some people do not even see any night abberations.  I like being able to see distance, intermediate, and near.  And so for me, I will live with this trade off.  Hope that helps you.  Kathy

[Richard123]

Thank you.  
Which lens do you have and are you going to get the same lens in the other the eye?

[eyecu]

Any lens can produce unwanted visual images. Monofocals would have the least amount as they have one focal point but you can get some edge phenomenon and glare from acrylics more than silicone and the older ones that had a flatter front surface.

Crystallens is a monofocal optic that moves so you will not have as much of the effect except that it is a smaller optic in the 4-5mm range so you can get some edge effect. The problem is that it does not move that much so you can give up the near which is a downside for what you have to go through in the initial stages of implantation.

The others have multiple images. So at night while you are driving and using distance, the near is defocused but will pick up the halo effect. Astigmatism exacerbates this effect so the less you have the better. When both eyes are done, the effect lessens as you have the same system in each eye. You also adapat over time with neuro adaptation so the effect is minimized and you do not notice it as much. Some not at all and others more. Just depends on the person. But I have talked with surgeons and optometrists that have had the Array implanted for over five years and say that it is amazing how it continues to get better.

There are people from all walks of life with different jobs and hobbies that have theses lenses. I also know of some pilots and they are very happy. The pilots I know have the Array and now the ReZoom due to intermediate importance of the instrument panel etc. As you can expect, there are some patients that you would think would not be happy and they end up happy and others that you would think would be dead on and are not as happy.

I truly believe that attitude and personality plays into it and realistic expectations. In the retrospective quality of life studies studies that were done, multifocal patients overall were happier than monofocal patients but that is not to say that monofocal patients are unhappy.

[Highsound]

Eyecu,
Read your explanation of what causes nightime halos, but what causes the indoor and dim light secondary ghost image of the primary image that causes everything to be blurry?
Like KD, I am seeing a distinct very bright light ring with inner spokes or something like that around all pinpoint lights like headlights and auras around all other light sources.
Of these aberrations, the ghosting is by far the worst since it's everywhere 24hrs except daytime outdoor when my pupil is small. You can accustom yourself to the halos especially if your other eye doesn't see them and can dominate.

My Doc gave me Pilocarpine Hydrochloride drops to use to try and narrow the pupil size permantely and eliminate all of the above.
It's effect works very well short term due to the pinhole effect. No ghosts or halos and 20/20 chart vision. Do you think it will accomplish his goal?
If it doesn't, at least I'm getting a break for now.

[K-D]

Richard, I have the Rezoom in my left dominate eye.  Yes, I am going to have a Rezoom in my right eye in September.
Just research as much as you can to decide what lens is best for you.
If I could have gotten by with just wearing glasses to read, I would have gone with the traditional lens.  But my intermediate vision is important to me. And I was told that to arms length would not be clear for me with the traditional lens..  So, for me, I would rather have the night halos, and circles, than to lose my intermediate vision.  But some people may get by with just readers.  I did also want to tell you that my halos are not as large as the ones in the website that you supplied.  I have soft halos around a horizonal light source.  It is smaller than the light source and soft.  No problem at all for me.  The circles that I have from vertical light source are much larger than the light source and very thin with spokes in them.  I have come to live with them as for me, it is worth the trade off because I do not do alot of night driving.  Also, I have the circles on anything that reflects, at night,  such as parked cars,  and the reflectors on the roads.  (At night only.) Important to know if you do a lot of night driving.  Then again, you may have none of my night abberations because I have astigmatism. Just research as much as you can about the lenses, and get the very best doctor you can. When I see the circles at night, I just remember the thick coke bottle glasses my mom had to wear after cataract surgery, and it seems to put things in perspective for me.  All in all, I have great vision in my left eye. And have learned to live with the lively night show.  Best of luck to you Richard!

[K-D]

Highsound, I am still hoping that your inside vision will clear up for you. I had no hope of clear inside vision, without laser,  after two months of blurry inside vision.  Now, it continues to improve, going into my fourth month.  Maybe asked for a pair of glasses to wear while your eye heals.  That helped me greatly.  I was not so frustrated when inside. I wore the glasses all the time. Then little, by little, I notice that things were getting better.  Now I never wear glasses, except to read, and then only under certain lighting conditions.  I never even notice when I walk inside from outside.  And for 3 months, it was a dramatic change in vision.  Your eye has been through a lot.  Maybe all it needs is time to heal.  The best of wishes for you Highsound. Kathy

[K-D]

Richard, put in your search, (IOLs New advances.)  Very interesting information about about the lenses.  Guide to Iols by Dr. Slonim should come up.  Hope it help you. K-D

[Richard123]

Thanks, I am just getting started on gathering information on IOLs and this is all helpful.
I have also come across some articles and studies on the internet that compare the advantages and disadvantages of the various lenses.
And also some information about mixing and matching lenses.
Here are some that I have found helpful

http://www.eyeworld.org/ewweeksupplementarticle.php?id=104
http://www.eyeworld.org/ewweeksupplementarticle.php?id=105
http://www.lachmanconsulting.com/EyeQRpt1.pdf
http://www.eyeworld.org/supplements/2006%20AMO_SF%20DAILY%20MAY%20INSERT.pdf
http://www.ascrs.org/Meetings/Annual-Symposium/06am_PhyHandouts/19-103.doc
http://www.crstoday.com/PDF%20Articles/1005/CRST10005_supp.pdf

Related to that last one, the archive at Cataract & Refractive Surgery Today (http://www.crstoday.com) has a lot of information that I am trying to go through.

[Eagle eyes]

Hi,
As I recall on another thread, you had a crystalens exchanged for a ReZoom. I also thought you might have your IOL decentered. If indeed this is the case, this would explain your ghosting day and night. This is different from the normal halos or fuzz as some people describe as associated with ReZoom (and ReSTOR to some extent.) When your Pilocarpine is working and making your pupil smaller, it cuts down on the halos/ghosting from the decentered IOL, I believe.

[Highsound]

The decenterd IOL was recentered and sutured to the iris 3/6.
Follow up exam by another Doc reported it was perfectly centered but slightly tilted. He said that could be causing the ghosts and halos, but didn't really know for sure.  
If I knew for sure the tilting was causing the problem, I would probably look into another surgery to straighten it even with the risks involved in a 4th surgery. To assume that risk without knowing it will fix it is difficult.
Using Pilocarpine every 4 hrs or so eliminates the aberrations, but they come back even worse when it wears off. Perhaps using it will prevent any possible future visual adjustment, but the short term relief is welcome.  
Like others, I'm searching for answers, so I can get on with my life. I even called the mfg of Rezoom for opinion input, but they turned my inquiry down with "we can't give medical advice" after initially telling me they would look into it.
I am getting the impression that most Drs. and IOL mfgs. are more concerned with patient turnover than patient satisfaction. The lack of honest in-depth pro and con consumer info about such a common surgery is astounding, and results in Drs. making their patient's decisions.
The help you and other professionals who frequent this forum give is an exception to this statement and is greatly appreciated.

[Davidd]

I had crystalens put in both eyes about 3 months ago. Though I had an unusually long post-surgery reaction (8 weeks of extreme light sensitivity and pain), I am happy with the IOLs. I do not have any night time halos or anything else. I only need glasses (1.25) for extended reading with small type. I also have a very slight out of focus effect at long range but not enough to require correction. My intermediate vision and close vision is great. I am a 46 year old male in otherwise good shape and lead a very active sports life, these IOLs are turning out to be a good decision for me so far.

[K-D]

Wonderful news David.  Very happy for you!

[Richard123]

Davidd did you know your nighttime pupil size when you had the crystalens put in? I assume it must be smaller than the 4.5mm optic of the lens if you have no nighttime glare problems.

K-D Related to your descriptions of your nighttime vision with your Rezoom lens, have you been in other darkened situations since you have had the lens put in? I am particularly curious about what people experience in a movie theater or in a restaurant with a darkened atmosphere. Darkened situations other than just being outside and/or driving at night.

[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.

[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?

[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]

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

[LLGirl]

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

[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.

[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?