One Rezoom, One Traditional IOL

[mk57]

Had a Rezoom implant right eye on 6/27.  Planned to have Rezoom in left eye also.  Distance vision is good, 20/25, with bright natural light I can read very well, even small print.  Basically get along without reading glasses except early morning or in very low-light situations.  Problem is, at night, there is a definite problem with ghosting, particularly while watching TV when there is dark background, and of course the light show when driving.  Am now functioning very well with a distance contact in the left eye.  However, can't keep the contact in 24/7,  my eye gets very tired, so at night when I take the contact out there's a definite problem.  Wanted new glasses, but doctor said it wouldn't work because of the prescription necessary to correct vision in my left eye.  Scheduled to have the left eye done soon.  Dr. won't put in Rezoom because of the continuing problems with the first.  Will have traditional IOL, although he says this usually doesn't work well.  My question, since I'm doing fine with a distance contact and a Rezoom now, why shouldn't one of each work?

[Forum-OD-MP]

rezoom works much better when both eyes are corrected.  so if you get a traditional IOL you'll always have the same problems you have now.  having another rezoom may (or may not) fix some of those symptoms.

[K-D]

I recently went in to prepare for my second Rezoom implant.  I had my initial Rezoom implant last Feb, and although my results were not immediate, which I was told they would be, the lens ended up being excellent, after 3 months.

The only disappointment I had remaining was the night aberrations that I was told would lessen with the second Rezoom implant.  In fact, I was told repeatedly that Rezoom was made for bilateral implants and best vision is obtained when both eyes have the implants.
So, I am now in the same situation as the poster.

I was told by my doctor,  in my recent visit, that a monofocal lens would be the way to go with my Rezoom, because my remaining cataract eye has so much astigmatism. He said that I would require eye surgery before the implant, months to heal, and possible distorted vision. Yikes. This would scare anyone off. And these are the same eyes I had when I first walked into the office.  Quite frankly I am really angry.  If this was the situation, I should have been told of this before the first surgery, yet it was never mentioned. I would have never agreed to having one multifocal implant and one monofocal. Now I am left with the delema of having two different systems in my eye, which from everywhere I read, does not work, or risk a explant which is risky.  Any suggestions would be greatly appreciated as I am really stunned by my last visit, after hearing for almost 7 months, my vison would only get better with the second Rezoom.

[hud]

go get another opinion- ask your surgeon and any other how many they have implanted, and their results. This is where more is better.

[K-D]

Thanks Hud.  Will do.  Problem is that this doc is suppose to have implanted the most in my state. Superb reputation. Internationally known. Just wish I would have been told upfront that my astignatism in right eye would not work well with a multifocal.  I would have never gone with one multifocal and one traditional. I was entitled to this informaton before making my decision. And for the last 7 months, a second Rezoom was planned.  I have the same astigmatism that I initially had. So I have no idea why the complete change in plan. Very upsetting to say the least. Thanks again for your response Hud. Very much appreciated.

K-D

[JodieJ]

I can certainly empathize with your anger.  I'm no expert about refractive surgery, but it's my impression that Lasik and PRK are quite effective in reducing astigmatism.  Why can't you have limbal relaxing incisions at the time of your second ReZoom surgery, and then do a Lasik or PRK enhancement at a later date for any residual astigmatism.  My surgeon uses this sequence successfully with his ReStor patients.  And ReZoom lenses are supposed to be more forgiving of astigmatism than Restor.

[K-D]

Good question Jodie,

I can only come to one conclusion, as to why the second Rezoom changed to, "better to have a monofocal with your astigmatism". I was in a comparison program comparing the different lenses.  Generally the informaton is completed now.  All surgeries left, have to be done before the 29th.  No longer an incentive to do the Rezoom at the discount rate, especially if it will require tune up.  I hate to believe this.  But it is the only answer that makes  any sense to me, after hearing since Feb, that, "after the second Rezoom implant, your vision will be even better because Rezoom is made for bilateral implants". I did not go to the office to have a multifocal lens.  I had no idea that they even existed.  Now I am sure left in a mess, because I do not want two different systems in my eye, and a good job was done to scare me against having another Rezoom implant due to my astigmatism.  I am more than angry.  I feel like I was used!

[JodieJ]

K-D, your explanation may be on target.  And your superstar surgeon seems to be lacking in the medical ethics department.  I agree with hud; get other opinions.  Many people have excellent results with multifocals after having LRIs and Lasik/PRK enhancement.  And I know an optomotrist whose 2D's of astigmatism was entirely eliminated by limbal relaxing incisions at the time of his cataract surgery.  There have to be other doctors in your community who specialize in both cataract and refractive surgery.

[K-D]

Thanks Jodie,  Will take your advise!

K-D

[JodieJ]

Good luck and please keep us posted.

[K-D]

Thanks Jodie,  I sure will. But I am going to need a seeing eye dog before even thinking about more cataract surgery. I am wondering how Hoddy 44 is doing.  Sure hope everything turns out for him!

[JodieJ]

I wanted to let you know that the Alcon AcrySof IQ lens (which I got last Monday) seems to be working out fine.  Compared to my other eye, which is 20/20 with a contact lens and doesn't have a cataract, colors viewed through the IQ are a bit brighter.  What's significant to me has been the absense of problems--i.e., no pain, no dry eye, no flickering vision, no glare, no difficulty with night driving.  I hedged my bet as to what to do about my "good" eye by getting measurements for both an IOL and for Lasik/PRK.  But based on the good results I've had so far, I'm going to get an AcrySof IQ for that eye, too.

[fenbit]

I had cataract surgery done in Feb. 06.  Had monofocal IOL implanted.  Not really satisfied with results.  I believe my vision is now 20/40.  Switched eye docs.  New doc says that is acceptable in his practice?  I expected 20/20.  Was told by doc. that did surgery that I would only need reading glasses.  That would be seven months ago.  Too late to change lens?  Should the surgeon who implanted lens be responsible for better?  I've though about filing complaint with board of medical examiners.

On the other hand.  20/40 was good enough to get restriction off of my driver's license.  Second surgeon does not do multi-focal lens implants.  I though perhaps I could get multi-focal in the other eye and that would improve both distance and near vision and the halo effects would be mitigated by having only the one eye with multi-focus?

However, after reading all of these and other posts, I scared sh*&less about even pursuing the multi-focal lens???

Any comments would be appreciated!

fenbit

[K-D]

Fenbit, the only thing that I can tell you from experience is that I have only one multifocal implant and have the lively night show.  Just having one does not mean you will escape night aberrations.  Then again,  depending on your eye, you may not have any aberrations.  It depends more on your eye than having just one multifocal implant.

[fenbit]

I guess that's the problem, you just never know how they will turn out.  It's frustrating.

[JodieJ]

Unfortunately, cataract surgery isn't as exact as Lasik vision correction.  I think that 20/40 would be considered an acceptable result in just about any practice, especially if you had preexisting astigmatism.  If you're really disappointed, you could have a Lasik or PRK enhancement.  From what I've read, having one multifocal IOL and the other a monofocal doesn't generally work very well.  Would you consider wearing multifocal contact lenses?  That's what I'm planning to do.  They should give you good vision at all distances.

[fenbit]

Unfortunately, I have tried contacts.  I have pretty dry eyes and when I tried them, by the end of the day, both eyes looked like raw hamburger.  Had to take them out early in the day - no way could I wear them all day and night.

Right now, I can read the newspaper, books, etc.  Also have no problem with the computer screen.  I only have problems reading very small print and menus in restaurants when the lighting is bad.  I believe if the vision in my IOL eye was 20/20, because of the risk and uncertainty, I would be a pretty happy camper.  Perhaps I should look at lasik or other.

I have been wearing progressive lenses for many years and if they are not ground exactly right and fitted right, it was always a pain trying to keep my head at the right angle so that I was looking over the correction for near vision.  It has been a delight not having to wear glasses while driving.  Also great to go to football games, concerts, etc. and be able to see very well without glasses.

Thanks for your suggestion.

Oh, from what I read, it seems that success seems to come with large numbers of procedures.  Do you (or any readers) have any comments on eye clinics that specialize in lasik (cataracts) vs. private opthomologists who run a regular practice and also perform surgery?  I live near Sun City and there are several of these institutions - they do thousands of procedures - it would seem they would be pretty good at it.

[K-D]

Is light dependent vision unique only to multifocal lenses, or does it happen with traditional lenses too.  My vision is perfect outside, but is not as clear inside when the light changes, because my pupil is not as constricted.  Would this happen also with a traditional lens?

[fenbit]

Good question.  I would have to say that I notice the same thing.  When taking my driver's license test, they had one of those funky little poorly lit devices and they said that my vision in both eyes was 20/40.  However, when driving in the bright sunlight, my vision in my rt. eye (IOL) is vastly superior to my uncorrected lt. eye.  My GUESS is that the light does make a difference even in non multi-focal lens.  

I guess I will just wait it out for awhile - sure would like to have lt. eye done, but with all correction - near, mid and distance vision.  I've read on one of these blogs that ReZoom is coming out with new lens.  Perhaps there is still hope.  Would it make any difference if you put the multi-focal in your non-dominant eye (assuming my lt. eye is my non-dominant?)

[fenbit]

I was just re-reading your original posting.  You mentioned something very significant to me in my decision making.  When I first had my mono-focal IOL done, for several if not many weeks, I had the same problem with the white lettering on on the black background. IT DROVE ME NUTS!  Thank god it did go away.  I could not enjoy a movie.  I could not enjoy my new HD TV.  It was horrible and extremely distracting.  That to me is a quality of life issue.  If any multi-focal lens has that characteristic on an ongoing basis - it will be a no brainer for me.  Notice it most at the end of my favorite shows, most of which are compliments of Jerry Bruckheimer (LOL).

[K-D]

Thanks for the info.  I guess all IOL are light dependent.  Too bad.  Would be so nice to have perfect vision outside as well as inside.  Interesting to hear about a new Rezoom.  Maybe it will work better with astigmatism and that would really solve my present delema.  Hope so. Nothing as nerve wrecking as sight problems, in my opinion.  Bumped my head and for the last month am having horrible black floaters only in the eye that I had the cataract surgery.  No retinal tear or detachment.  But they are round rings and the thought that they may be permanent is just too much to take.  Oh to have eyes of a twenty year old again. Oh to be twenty again.;-)

[K-D]

Jodie,

Sounds like your lens is working out fantastic!  Good for you!  Your research paid off.  Can you tell me, is your sight blurry to arms length?  Or do you just need glasses to read, which would have been no problem for me, and I told the doctor this. But I was told in my initial consultation, that vision to arms length would be blurry.  And that is what scared me into a multifocal lens, and into the Research program. However, now I am  told to go with a traditional lens in the second eye, due to astigmatism, since the study results are completed. If I would have needed glasses only to read, and am now in a situation with one multifocal lens and told to go with the traditional lens in the other eye, due to astigmatism, the same astigmatism that I walked into the office with,  I am going to feel very dupped.

[JodieJ]

I'd rate both my near and intermediate vision as being unsatisfactory.  As soon as my vision has stabilized in both eyes (second surgery next week), I'm going to order bifocal/multifocal contact lenses and progressive glasses (for when I don't feel like wearing contacts.)  I hate being  constantly frustrated by my inability to see things clearly.  If I had been a candidate for either monovision or multifocals, I probably would have gone for it (in that order).

I really don't think you'd be happy with one ReZoom and one monofocal lens.  I recently read that ReStor lenses are now indicated for people with 1.5 to 4.0 diopters of corneal astigmatism who agree to have post-surgery Lasik enhancement.  (My surgeon was able to eliminate all of the 1.50 D of astigmatism in my right eye with two limbal relaxing incisions, so you may not even need Lasik enhancement if you're lucky.) In your place, I'd consult at least two surgeons who do both ReZoom and ReStor. (Unlike hud, I'm not a purist.) Depending on their recommendations and your goals, you could do either multifocal lens in your second eye and get good results.

[K-D]

Jodie, cannot thank you enought for your info.  Was the reason that you could not go with the multifocal because of dry eyes?  I do not know if I have dry eyes or allergies.  But I have to use drops to assist with the burning and redness, which I had before cataract surgery. Could you direct me to a site about the multifocal and traditional lens? I have read patients say over and over that their doctors told them that multifocal and traditional lenses do not work well together. But I was wondering if there is a sight about it. Thanks again!

Kady

[JodieJ]

My best guess as to why your surgeon recommended a monofocal lens for your second eye is that having to do limbal relaxing incisions/Lasik enhancement requires more of his/her time without additional compensation, and s/he doesn't want to be bothered now that their research project has ended.  (Yes, it sounds awful.)  How much astigmatism do you have?  Aa I posted earlier, I read that Restor lenses are now recommended for people with 1.5 to 4 diopters of pre-existing astigmatism, as long as they agree to have Lasik enhancement post-surgery.  (And I bet you fall in this range.)

There's no single website that discusses mixing monofocal and multifocal IOLs.  I've read lots of articles in ophthalmology journals, and I've never read anywhere that this is a good thing to do.  Everybody (including the manufacturers of multifocal lenses) recommends multifocals in both eyes.  So you're now in a position where you need to get opinions from other cataract surgeons, preferrably (in my opinion) those experienced with both ReZoom and ReStor.  But there's an advantage for you in doing this.  If the research project hadn't ended, you'd almost certainly be getting another ReZoom lens (given everything you'd been told), even if you might have done better with a ReZoom/ReStor combo.  Now you have the chance to get exactly what will be best for you.

I had retinal surgery last January to remove a layer of scar tissue from my retina.  The surgery was very successful, and I could actually read the 20/15 line before I started getting a cataract.  But my retina is still healing, and from what I've read in the journals it will probably never be quite normal.  One of the four cataract surgeons I consulted thought I'd be a fine candidate for ReStor despite this.  But I was wary about putting a multifocal lens in an eye with a less-than-healthy retina.  After reading some of the posts on this site about the horrible results of implanting multifocals in eyes that weren't 100 percent healthy, I decided against doing it myself.

[K-D]

I too believe what you have concluded about the change in plans to a monofocal lens.  Disappointed because he is an excellent surgeon..  But I just cannot believe that he was putting my best interest first when wanting to go with a monofocal lens, with the Rezoom, only  after the Research report was done.  I had already spoken to one of the Researchers. It was after this, that the monofocal became the way to go for the doc.  Transparent to me.  Also, disappointing. I had a great deal of respect for him.

I am so sorry to hear about your retina. Anything with the eyes is soooooo stressful.  I recently had a PVD and am having a weiss's ring and horrible floaters.  See a retinal specialist tomorrow.  I know floaters sounds so benign, but it can be life altering. And I had the most clear vision in this eye after the Rezoom implant.  So, hope the floaters are not permament. And wishing the best for you Jodie.  You are a great asset to the board because you are so knowledgable about the lenses  and you are not bias.

[sandy243]

I've been reading all your threads for over a week now, as I had my first ReZoom lens put in on September 18th. My doctor had intended to go with a second ReZoom, as I do a lot of work at my computer (college prof). I wasn't getting the close up vision for reading that I needed, both professionally and recreationally, although driving and computer reading are great. So I looked at what I could find on the Net, read Dr. Milne's very helpful article online, and then talked to a friend from work who had one ReZoom and one ReStor. I then talked with the professionals at my eye clinic, and we all agreed that one of each would be best for me. Had the ReStor put in today, and although the dilation is slowly going down, I'm really pleased. I have NO adjustment problem between the two lenses. While my eye feels a little "scritchy," it did last time, too, and was pretty much gone by the next day. By Friday or this weekend, I should be able to read with no problem (and frankly, the ReZoom is getting better at that on a daily basis, too). So far, I would highly recommend one of each to anyone who both does a lot of reading and a lot of computer work. I'll keep y'all posted as to progress--especially the person having this done in October!

[K-D]

Great news!

[sandy243]

I am now four days post-ReStor in the left eye, and I can read just fine. I'm still seeing some improvement as the two eyes learn to work together and my brain learns to work the two eyes, but so far I am very, very pleased. I don't have any problem with the two different lenses, and I am reading my newspaper and paperback books (which I could not yet do with the ReZoom only), working my crosswords, basically doing everything I could not do before without glasses. My biggest problem? Remembering not to reach for my glasses when I get up out of bed, when I get out of the shower, etc. (And thanks, K-D!)
The halos don't seem to be as bad with the ReStor lens, and when both eyes are open, they are much less than with the ReZoom only. Nice little bonus I didn't expect, there. I actually feel that I could drive at night now, where before I was very uncomfortable doing so. So far, so good!

[K-D]

Sandy that is such great news.  It is so good to hear when things turn out so well. And very interesting to hear that with one Restor, after the Rezoom, the halos lessen.  Sounds like a great choice all around. Thanks for the info. Best wishes!

[sandy243]

One week later still, and all is well. I am still seeing improvement in the vision of both eyes. I've been able to read my paperbacks and newspapers, and my husband noted today that I am seeing better with less light--with the cataracts, I needed to turn on the light by my chair even in daylight to see well. I am almost used to the eye drops, but really looking forward to dropping from three times a day to two, then from two types of drops to one...I'll be finished with drops around Thanksgiving, but it has been well worth it. Enjoying my new, first-ever, really good sunglasses-that-don't-look-ugly-and-fit-over-glasses, too!

[K-D]

Good luck Hoddy!  And just remember, that things are not always clear at first for everyone.  I was so anxious because my distant vision was blurry.  And then it became crystal clear.  Just trying to give you a heads up should you have the same experience.  Best of wishes!! K-D

[K-D]

Hoddy, how are you doing?  Surgery was on the 12th.

[geb1]

I received a monofocal IOL in left eye for cataracts in 2001.  I had never worn glasses prior to this and did not know I would loose up close / intermediate vision in this eye.  Now it is necessary to have cataract replacement surgery in right eye.  The doctor (same as did 1st surgery) has recommended ReZoom lens.  I see several posts in this forum indicating this may not be the best idea.  Can anyone refer me to "articles" where this is discussed?  Has anyone had this combination done and would comment on how well (or how poorly) it has worked?  I like the idea of getting back my computer / reading vision if only in one eye.  Basically, I have been using just the one right eye to read for the last few years until the it also developed a cataract and now I use reading glasses with the surgeically corrected left eye. Thanks.

[K-D]

Jeb, wish I could give you sound info, but everywhere I have read, multifocals are best in both eyes.  Maybe have the doc set the next monofocal lens back a little to get some intermediate vision if you decide to go with a monofocal.  Best wishes.

[K-D]

Jeb, I do know that with my one Rezoom, and my other eye still unoperated upon,  leaves me with a feeling of unbalance. I am guessing that would be the problem with one traditional and one multifocal. Just a guess. I am no expert. Best wishes.

[cbates44]

My doctor is the first certified to implant ReZooms in this state.  I am the first to have the implants in this state.  I wish it was not so.  I have had, and continue to have, several issues with the ReZoom IOLs.  

I had my right eye done first.  It was very  myopic (-8.0 diopters), but could usually be corrected to 20/15, the same as for my left eye.  I had begun wearing progressive lenses several years ago, and was pretty satisfied with that arrangement.  I had tried contacts over the years, but was never satisfied with the lesser acuity that seemed to go with them.

My good vision came to an end when I developed cataracts in both eyes, with my right eye being the worse of the two.  After much haggleing with my health provider, I persuaded them to pay for ReStor IOLs.  When the time for the implantation rolled around, the doctor realized that the ReStor lens was not made for my prescrition.  After another wait, it was determined that the ReZoom IOL was suitable for me.  

I was told of all the problems that might occur.  Yeah, yeah.  Just fix my eyes so I can see again.  Right.

The right eye received the ReZoom IOL.  I was disappointed with the poor vision from the gitgo.  My sister has single vision IOLs, and she told me she could see well almost immediately after surgery.  Not so for me.  The doc called me three days after surgery to ask how I was doing.  I told him the good news was that I had NO pain or scratchiness.  I told him the bad news was that I could not see worth a (use your imagination).  He told me that he had heard that the multi-focal IOLs required a longer period of adjustment.  Right.

I waited for two or three months, and the adjustment never happened.  During that time the doc talked to lots of other docs and decided that my eye had stabilized.  Then, using some Kentucky windage, he did a ReZoom implant on my left eye.  I am much happier with the second attempt.  Outside in good light I have excellent, though slightly strange, vision in my left eye.  The strangeness is the ghosting that can be present day or night depending a lot on the colors of the objects viewed.  Arm-length vision was poor, as was reading distance.  I could read, however, with some difficulty depending upon lighting conditions.  And strange as it may seem, though I have an idea why, I could read better in lower light levels than normal.  

Back to the right eye:  It had been -8.0 diopters before the implant.  After the implant it was +1.0 diopters.  I had gone from being very near-sighted to being slightly far-sighted (BTW, having tried both, I prefer being near-sighted because at least something is in focus, something which can't be said for far-sighted ness, at least as I have seen [pun intended] it.).

The doctor then corrected my right eye with LASIK surgery.  Unfortunately it made me near-sighted again by about -1.0 diopters.  I am wearing a contact lens and reading glasses as I type this.  

As someone wrote earlier, the IOLs actually affect the quality of life.  I get lots of ghosting when watching TV.
Sometimes I will be wondering why the producers made something look the way it looks, only to realize it only looks that way to me.  

But the ghosting is much more serious when driving.  It obscures my view and is very distracting.  

The halos I see when driving at night, what others have called "night shows" are downright dangerous.  I limit my driving to familiar two-lane roads with little traffic.  I would give up night driving altogether, but I do have to drive to work every day.  The halo from a single headlight may appear to fill a whole lane of highway.  A car's taillight may appear to be the size of a bathtub.  It is terrifying in heavy city traffic.

I have had to give up riding my motorcycle and sidecar rig to work EVERY day.  I enjoyed being the nut who rode rain or shine, sleet or snow.  I may just sell all my motorcycles.  They don't do me much good since I have to be in before dark.  I really miss riding.

I have been competing in pistol competion for many years, though not lately.  I will probably have to give that up because I don't have the focusing distance needed to see the front sight clearly.  I went to Cabelas yesterday to look at non-iron sight.  I don't think I will be able to use them either.  The illuminated aiming points have halos.  Imagine that.  

Ok, I am done crying.  For now.  I am just very frustrated and don't know what, if anything, to try next.  I don't think my doctor does either, in fact he admitted as much.  

Does anyone have a clue what needs to be done?  Does anybody know if there is ANYTHING that can be done?

[hud]

go seek another surgeon's (or two) opinion.

[JodieJ]

geb1--With one monofocal implant, monovision (or modified monovision) with a second monofocal IOL might be your best bet.  Ask your surgeon.  Per everything I've read (including manufacturer's recommendations), multifocal IOLs are designed for bilateral implantation.  You could do some of your own research by entering word combinations such as "multifocal IOL bilateral" in any of the major search engines.

cbates44--Please follow hud's advice (above).  Get additional opinions from surgeons experienced with multifocals.