Range of vision for plano or distant monofocal IOL

[ddtla]

I had bilateral rezoom placed about 5 and 6 weeks ago. I see constant ghosting image with the rezoom and I am unhappy with the result. I am thinking about having them explant and placing bilateral monofocal lense set for plano or distant vision.

My question is with the monofocal lense set for distant, what is the range of vision that I can expect to see clearly without wearing glasses?
Will I be able to see clearly from 4 or 5 feet and beyond without glasses? Will I be able to see the face of the person sitting across the dinner table clearly without glasses?

I know that I will need glasses for reading but I would like to know what is the range or limit that I can see clearly without glasses?

[Forum-OD-MP]

"My question is with the monofocal lense set for distant, what is the range of vision that I can expect to see clearly without wearing glasses?"

assuming they actually REACH exactly plano (big assumption)...10 feet and farther: clear.  9 feet and closer: blurry.  NO READING.  NO COMPUTER.

"Will I be able to see clearly from 4 or 5 feet and beyond without glasses?"

10 feet and farther...clear.  anything closer...NO not clear.  the closer it is, the blurrier it will be.

"Will I be able to see the face of the person sitting across the dinner table clearly without glasses?"

you will be able to physically see them, yes.  but they will not be clear.

[ddtla]

Thank you for your quick respond.
I heard that you can wear bilateral multifocal contacts and this will allow you to see near, intermediate, and far with the monofocal IOL(set for distant). Is this true?

What other options do I have with the monofocal lense set for distant?
If I wear bifocal glasses, what is the range of vision that I can expect to see clearly? Will I be able to see sharply and clearly at all distances ( near, intermediate, and far) with the bifocal glasses?

Any comments or personal experiences will be greatly appreciated and will help me to make my decision.

[Ag-i-doc]

"I heard that you can wear bilateral multifocal contacts and this will allow you to see near, intermediate, and far with the monofocal IOL(set for distant). Is this true?"

well this is a trick question.  you stated that you already HAVE bilateral multifocal IOLs and you're not happy.  those IOLs have the same optics (or very similar) as bilateral multifocal contacts.  in fact, the optics design for the IOL's is based on and very similar to the design of the multifocal contacts.  so NO.  for you that would likely be untrue.  you'll be just as unhappy with multifocal contacts with your monofocal IOL set at distance as you are with multifocal implants.

"What other options do I have with the monofocal lense set for distant?"

bifocal glasses, multifocal glasses, monovision contacts, multifocal contacts (although already discussed that probably wouldnt work)...

"If I wear bifocal glasses, what is the range of vision that I can expect to see clearly? Will I be able to see sharply and clearly at all distances ( near, intermediate, and far) with the bifocal glasses?"

if you are talking about bifocals WITH A LINE ("flat top bifocals")...the top is 10 feet and farther.  the bottom is say 1.5 to 2 feet and closer.  no "intermediate" distance.  multifocal glasses ("progressives")...yes in theory for every conceivable distance there would be a spot in the glasses that you could see clearly.  you'd just have to learn to "find the spot"

[JodieJ]

I have monofocal aspheric lenses set to plano in both eyes, which give me excellent distance vision in all lighting situations, with no ghosting, glare, halos or other aberrations.  And there was no lengthy adjustment period to a new visual system; I was driving at night the day after surgery without problems.  But my near and intermediate vision are poor, IMO.  Anything within arm's length is noticeably blurry, although I don't have a problem seeing somebody's face across a table.  I wear bifocal contacts (or, occasionally, progressive glasses) most of the time, because I'm very fussy about my vision and hate blur.  (Other people with two IOLs at plano only wear readers occasionally--e.g., for menus, the newspaper and the computer.)  

With both eyes at plano, you could also get good near/intermediate vision by wearing a contact lens in one eye (reversible monovision).  Another alternative would be setting one eye at plano and leaving the other a little nearsighted (sort of a modified monovision).  This would give you good distance and intermediate vision; you'd probably only need readers for small print.

I've read your posts about your multifocal problems.  If you can safely explant your multifocals, I think that you'd be much happier with monofocal lenses.  I've found them to be problem-free.

[Jmadison]

I am 10 weeks post-surgery for my aspheric monofocal and the only noticeable visual deficit I have is reading newspaper print closer than about 18-24 inches (I'm able to use the computer as most print is large enough).  My current correction is -0.5, so I am slightly near-sighted.  It is a decent range of vision.  About six weeks ago, my correction was -1.0 and I was able to read the newspaper at a closer distance, but I did need driving glasses. All in all, I am happier at -0.5 than I was at -1.0, because now I only need some low-powered drug store readers for extended reading or for fine print.

My target was plano, but my result of being slightly near-sighted does have its benefits (I was told the final result would likely be +/- 1.0 diopter different than what was planned). Right now, I am able to use my surgical eye for distance.  My non-surgical eye has a multi-focal contact lens that on purpose under-corrects my myopia to about 20/50 so I use that eye for near.

[JodieJ]

I didn't mention that there are several designs for bifocal/multifocal contacts.  The ones I have (Triton soft bifocal contacts/www.gelflex.com/1-866-GELFLEX) use a translating design, which is totally different from the optics of a multifocal IOL.  They're sort of like bifocal glasses, with the top part of the lens for distance and the bottom for near/intermediate vision.  The prescription in the near/intermediate section can be a little different in each eye (if desired) for a slight monovision effect to improve intermediate vision.  (Mine don't do this, and I can still use the computer without problems.)  I think the Tritons are excellent contacts.  My optometrist charged me $300 for lenses that should last a year.  (These contacts can also correct astigmatism, if necessary.)

I also tried soft disposable multifocal contacts, which have optics similar to an IOL.  I didn't like them as well, although I didn't experience ghosting or halos.  I wore C-Vues for a couple of weeks (plano with a high add).  When you have 20/20 vision uncorrected, it's obvious that your distance vision isn't quite as good when wearing these contacts.  My near vision was barely adequate.

I've never worn gas permeable multifocals, but I know people who are very happy with them.  And another alternative for post-cataract surgery would be to wear a contact in one eye for reversible monovision.

[Susan12345]

Well, they closed our last thread where you wrote about your letter to Dr. Christenbury. I'm not surprised that he said have the other Restor put in, because that's exactly what my doctor said, that's what the Alcon Co. tells them, that the Restors are designed to work together and won't work with only one, which is why Dr. C told the one-eyed man to have the monofocal.  I go back and try to analyse what I should have done.  Obviously the Restor on the one eye was doing nothing for reading vision.  I told my doctor that and he said it would work when I had the other one done.  He KNEW I was using OTC reading glasses, he told me to.   I couldn't stand having one eye for distance and one for near, though I know many people do.  So in retrospect,  my only other alternative at that point was to have the Restor taken out and replaced by a monofocal of approximately the same degree of nearsightedness as my other eye, but I doubt my doctor would have done that even if I'd asked, and I was still naively hoping he was right, that the Restors would work.   The Alcon people have a good deal going, once you get one you're pretty much committed to the second.  But still, the 5 weeks between my 1st Restor and my 2nd, while my vision was confused with clear glass over the Restor eye and OTC reading glasses for reading, I didn't seem to have as much of the annoying fluttering as my eyes tried to adapt from near to far. Maybe because I was mainly just using the non-Restor eye.  Still, it makes make me wonder if only one IOl exchange MIGHT work if I had it set for -200.   Before surgery I was -400 in the right eye and -525 in the left.  If I couldn't adjust to bifocals I certainly could never adjust to monovision.  Anyway, if Dr. C has really done 5000 Restors, he MUST have had some that didn't work.  I'm curious what he tells them, he can censor his letters, but he has to see them face to face in his office.  I suppose, he tells them what my doctor told me, that my fluttering was due to being tired, I would read better if I didn't hold my books too close, and everybody else LOVES their Restors.  Susan12345 (the freak who doesn't love her Restors)

[JodieJ]

Any reader of this forum knows that many people are very unhappy with their ReStors.  In a perfect world (for consumers), there'd be some objective research available about patient satisfaction with their multifocals at various points in time post-cataract surgery.  This type of information would help patients and their doctors make better decisions about who should (or shouldn't) get multifocals and which lens (or combination) might work best in particular situations.  Unfortunately, this data doesn't exist.  I've said before that the field of cataract surgery seems to be dominated by corporate rivalry, and the major corporate players probably wouldn't benefit from having this information available.

Susan, it is not your fault that your ReStors don't work for you.  Possibly your topography findings will help your new doctor determine why they don't.  I'm sure that he can make recommendations about what you might do at this point.  As for Dr. Christenbury, you'll probably enjoy reading the comments by his patients (http://ratemds.com then click North Carolina).

[Susan12345]

Interesting comments by his patients, if he really does as many eye surgeries as he says, I can well believe his office must be like a factory.  The doctor who did my Restors wasn't like that, though.  I trusted him, he answered all my questions before the surgery, unfortunately I just didn't know the right questions to ask.  He was very defensive though after I'd contacted the Alcon Co. with my complaints, spent a lot of time with me and acted very concerned, but certainly never admitted he shouldn't have done the Restors.  The thing about cataract surgeons though is that they're kind of like OB's, they probably go into the field because they generally get good results, they like grateful patients, it's a whole different personality from say an oncologist who has to know he's going to get a lot of bad results.  Susan12345

[K-D]

Could you please explain to me what plano means.  I have a multifocal set at plano and now am advised by two doctors to have a monofocal set for distance in the other eye.  How will this work?  Won't it leave a feeling of imbalance?

[Ag-i-doc]

plano means zero rx.  we dont ever write "0" b/c it can easily be confused in a transcription error.  so when we mean "zero" we write/say "plano".

dont know if you'll have a "feeling of imbalance" or not.

[aimee37]

K-D, please get another opinion.  The two doctors you've seen will not have to live with vision from a multifocal lens in one eye and a monofocal in the other, but you will.  As I recall, you live in the St. Louis area, only about a 4-hour drive from Indianapolis.  I think it might be worth the extra time and effort to see Dr. Kevin Waltz, who is reported to have expertise at solving ReZoom problems and explanting IOLs.  (Please don't tell me you're in an HMO!)

[aimee37]

K-D that is a very interesting question. At least that way you would still have some near vision. Do you need readers for your non- surgical eye? I was wondering how  your vision is with one Rezoom only. I'm trying to figure out what to do next. I'm running out of time. I only have 2-3 weeks left to decide, although monofocal lenses are beginning to look better and better. As for my aberrations, nothing has changed. Ghosting is still there and the lack of improvement is making me realize the sad reality that Rezoom lenses are not for me.

[aimee37]

I saw my eye doctor yesterday and asked him 2 pages worth of questions.  Re the wave front analysis for checking decentering, he said that would tell absolutely nothing for someone with Restors.  I didn't ask him about it for Rezooms, don't know if it would give any uesful info for them the way the much touted Dr. Waltz said it did for Blue.  According to my doctor the slit lamp exam is sufficient for checking placement of Restors, he said with the circular rings it's immediately obvious if the Restors are in the right place.  I mentioned that the doctor who put my Restors in knew that they didn't work for near vision and still told me to have the 2nd one put in, he said that was right,  he would have told me EXACTLY the same thing.  Of course doctors never like to bad mouth other doctors, but it's clear, the Alcon people have all the doctors convinced that even if the 1st one doesn't work the 2nd one will somehow magically make it do so.   It sure would be interesting to know often how that actually happens, like you said all the research is basically done by the companies making the products.  I asked about the corneal vs lenticular astigmatism and he said that since I didn't have corneal astigmatism, by elimination it had to be in the lens.  I asked if that was due to a defective IOL, since I no longer have a natural lens and incredibly, he said it was possible but he'd had had a patient who had lenticular astigmatism, had a IOL exchange and STILL had lenticular astigmatism with a different lens. (One of the many risks of IOL exchange is increased corneal astigmatism, but he said this guy definitely had lenticular astigmatism).  He couldn't explain it, it just sounds like that guy was like me, one of those people who if it weren't for bad luck would have no luck at all.....Susan12345  

[aimee37]

So what did your doctor recommend that you do, given all the problems you have with your ReStors?  Did he have any suggestions for improving your situation?

[aimee37]

It has been over a month since my last posting. As I mentioned before, the surgery itself (to recenter the right Rezoom lens and clean the bag) went very well without any complications. My goal was to let the eye heal and let nature take its course. I did want to focus (no pun intended) on my eyes and wait a few weeks before deciding what to do next. Dr Waltz warned me that there may be an adaptation period for the repositioned eye and also he expressed his concerns that there may still be some aberrations because of my very large pupils.

Repositioning of the right eye helped in some ways but not in others. My outdoor vision after the surgery was simply stunning. No glare or ghosting during daylight; however, indoors and in low light conditions, ghosting was still an issue. The loss of contrast is another issue that I'm still having difficulty adjusting to. This is mainly because of the type of work that I do. I wish I recognized this problem earlier on, but in my mind, I was dealing with one aberration at a time. Another problem that made this process so difficult, is my severe dry eye. Thankfully, after almost one year, the dry eye problem is finally subsiding and getting back to normal. I go days without eye drops and when I do need them, it is one drop a day in each eye (Systane).  

Susan - hang in there. It took 11 months for the dry eye symptoms to diminish. As I mentioned earlier, Dr. Waltz was concerned with my large pupils and the adaptation to multifocal lenses. After careful evaluation, I have decided to have the Rezoom lenses explanted. The right eye will be explanted next week and the left eye the following month. The vision out of the left eye is relatively good (near, intermediate and distance) except for some PCO. Perhaps there may be a possibility of good vision with the Rezoom in the left eye and the monofocal in the right dominant eye. I'll have a month to evaluate my vision before proceeding with explanting the lens in the left eye.

I'm not sorry that I had surgery to recenter the right eye. I did see some benefits, unfortunately, I still have low light aberrations (ghosting). This way, I at least know that we did what we could before giving up on the Rezoom lenses. I guess if I wasn't born with my large "Barbie doll" pupils (even though I'm a guy), the outcome could have been better.

I also want to mention that everyone I've dealt with at the Eye Surgeons of Indiana have been very helpful and have taken their time to listen and explain the various options. They have been extremely patient with me and have gone above and beyond to help me make the best decisions. At no time have I felt like I was being rushed out of the office. I truly believe that they are looking out for my best interest and outcome. I say this because my other "second opinion" visits were frustrating because no one could relate or took the time to understand the issues I'm dealing with.  I'll update you soon after the surgery.

K-D    I think I'll be able to answer your question. Perhaps a Rezoom and monofocal may still work . I'll have one month to evaluate the outcome. I feel like a pioneer.

[aimee37]

Well, he didn't have any new recommendations, it's just a matter of making a decision, do I want to take the risk of an exchange or not. At least he laid out the risks in advance, if only the doctor who put my Restors in had done that.  If I decide to have it done and anything goes wrong, I can't say I wasn't warned. I'm just so terrified.

K-D, I hope your surgery goes well, let us know.    Susan12345

[aimee37]

Sorry, I meant good luck to you,  Blue on the surgery.  K-D, I hope whatever you decide goes well also.
Susan12345

[aimee37]

Thank  all of you for your advice and information.  Jodie, I absolutely cannot figure out what to do yet. I was am terrified to have an explant. Yet, I do not want two different visual systems. And I am angry that a multifocal was put in my eye to begin with, if this doctor did not think a multifocal would work in the other eye.  Presently, I have imbalanced vision and would think it would be worse with a monofocal implant in my second eye.  This I could not stand.  So, no answer yet.  But Thanks for the name of Dr. Walze.
I am expecially frustrated because two friends that recently had monofocal implants can read and see distant without glasses.  This I have read over and over again is impossible.  Yet, they do so very well.  To be honest, I am as confused today as I was a year ago when deciding what to do about the lens implant.  If I truly could not see anything with a monofocal to arms length but blur, as I was told,  that would stress me greatly.  But everyone that I come across with monofocals can see better than I can, and without glasses.  I need 250t power for reading. Can only see to arms length inside.  Yet, I am told I am plano. Susan, I am so, so, sorry for your situation. I know the stress you are under. I never realized how life altering visual aberrations and focus problems could be.  If I could get this Rezoom eye fixed to see inside, I think I would just let the other eye go with the cataract. Right now looking at my webtv screen, I see only white, and the room is a total blur past my wrist. Yet, I am told I am plano. I do not understand this. Totally confused.  

[aimee37]

Re having one multifocal and one monofocal, obviously, if I do have my Restors removed I'll know what that's like for the period between having one done and the second.  So that's one more  big decision, trying to figure out what power differential I could tolerate if I only have one eye done, if anything went wrong and I decided not to have the 2nd done or if my vision was ok enough with just one not to risk the 2nd.  My Restors are basically monofocals (with fluttering, dry eyes  extreme light sensitivity and some farsightedness).  I've read that they try not to have more than a difference between the 2 eyes of 2.00 (when doing a monofocal on a person with just one cataract).  My doctor said that most people could tolerate a difference of 3.00, so he said I might have a -3.00 in my right eye.  But actually I am now +1.00 in my right eye,  and +0.50 in my left, so a -3.00 in the right eye would give me more than a 3.00 difference.  Maybe a -2.50 in the right, the bad eye with the lenticular astigmatism, another thing I didn't know existed a year ago.     Well, no mattter what I'm still going to be constantly switching glasses back and forth the rest of my life.   Assuming I'm not blind and and can still wear glasses.  I look back in such total amazement that the switching annoyed me enough that I was willing to have 2 eye surgeries when otherwise I would only have had to have one.   I just had no clue all the other problems that were in store, and my doctor who did my Restors sure never gave me any idea.   I HATE him.  And  I  think now, how many more problems may be in store if I have an exchange.  In some ways it would be a lot easier if I didn't know an exchange was even possible and could figure out how to live with what I've got.  Which I'll probably end up doing, but I'll ruminate about it endlessly lst.  At least I can tell everyone who reads here, DON'T HAVE RESTORS!!!!!!!!!!!!!!!  

Blue, did your doctor say the wavefront analysis could determine decentering just with Rezooms?  Because my doctor (the new one) was very definite that it would tell nothing for Restors.

Susan12345

[aimee37]

I think you can have monofocals basically set for whatever distance you want.  Most people have them set for plano, and wear reading glasses, but this is definitely not comfortable for people who are used to being nearsighted.  Given all the problems you've had with the Rezoom, it sounds like you'd do better with a monofocal in the other eye even if you're unbalanced.   Or if the 2nd cataract's not bad enough to have surgery yet, definitely just wait on that one.  But it really sounds like your Rezoom eye is bad enough to be worth the risk of an explant.  At least you only need one explant.  I keep thinking, I  might be lucky enough to have one successful explant but two, no way.  WHY did they ever invent these lousy multifocals anyway?  Well, that's easy, money.  The companies see a huge wave of baby boomers coming up with cataracts who don't want to wear glasses, and as far as they're concerned, if some of them have lousy results, that's just the cost of doing business.   Anwyay, I hope thing's get better for you.   Susan12345

[aimee37]

I am a 10 week survivor of an explant, but it was done only 4 weeks after the original surgery.  I needed the explant because the wrong power monofocal IOL was inserted. My decision was to go to a teaching hospital for the explant just because I thought if complications developed I would have more access to specialized care there.  When I was seeking doctors to do an explant, some did advise against it as being too risky.  I chose a surgeon who did several exchanges a year rather than one who had only done a few in their career.  That was my way of what I thought was minimizing the risk that could be minimized, but it was still an extremely nerve-wracking experience; even the surgeon I did use stessed that it was the least desirable option.  In my view, it had the greatest risk, but also the greatest benefit, if all went well, of putting me in the position I should have been in originally.

[aimee37]

Glad it turned out ok.  What other options were you given?    Susan12345

[aimee37]

K-D, I suspect that your friends can see distance and read because one (or both) of their eyes are slightly nearsighted.  (I think this is the ideal correction for distance vision with monofocals.)

Per his website, Dr. Kevin Walsh is both an optometrist and a board-certified ophthalmologist.  He apparently has special expertise in explanting IOLs.  He has a video of his explant surgery on his website, with voice over commentary containing tips for other surgeons.  He doesn't seem to believe that there is a time limit for doing this surgery safely.

[aimee37]

You don't have to worry about increased blur to arm's length if you were to get monofocal lenses and set both to plano.  If you're wearing +2.50 reading glasses now, your near/intermediate vision won't get any worse.  (It might even improve!)

[aimee37]

My original monofocal cataract surgery left me at -3.0 dicpter correction for my dominant eye when I was supposed to be plano.  The other options I was given besides an exchange, which was the most invasive option, were to reverse dominance (that is, make my dominant eye my non-dominant eye) or lasik.  I was MISERABLE with my dominant eye "permanently" corrected to -3.0, so I went through the exchange because I did not think I could reverse dominance and I was not comfortable with possible complications of lasik.

As I posted above, the exchange surgery has over a period of weeks left me with a -0.5 correction, meaning I can read about half of the 20/25 line.  At -0.5, I see near, intermediate, and distance decently. The only noticeable visual deficit I have is that I need +1.25 readers for small newsprint. I have some driving glasses from when I was -1.0 during my healing period and I sometimes use them for night driving if I feel I need crisper vision (I'm not sure if they are a crutch or not, but for day driving, I'm fine).

I had posted this in another thread, but I thought it was very interesting, because I have been wondering what an ophthalmologist would choose:

Dr. Waltz has multifocal implants himself according to a journal article (the Array lens from Advanced Medical Optics).

[aimee37]

This is a quote from Dr. Waltz's website:

"He was one of the first surgeons in Indiana to use lasers to correct near-sighted vision, and was the first ophthalmologist in the world to receive the Array multifocal lens as a patient."

[aimee37]

Jodie, I found a website on Dr. Waltz from his university but no video of an explant on it.  What is the URL?   Though truthfully, I'm just a little suspicious of ANY doctor who has a website.  The good ones get more than enough business without advertising.

Jmadison, I assume you must NOT have been nearsighted before your surgery.  Did they just get your IOL mixed up with another patient's, or label it incorrectly?  It's scary all the things that can go wrong with any surgery.  At least doctors are now required to have the patient mark the correct body part before surgery.  Could you see ok with glasses with the nearsighted IOL or just couldn't adapt to it at all?  People are always talking about their dominant eye here and I never knew which one mine was, finally found a self test on an archery site that told how to determine it, according to that test my left eye is dominant even though I'm righthanded, but when I asked my doctor about it he sort of dismissed it as a non-issue. Anyone know when and why it's significant?    Susan12345

[aimee37]

Thanks so much for Dr. Waltz's name. I am glad to have it.  But I just cannot see me actually having the courage for an explant.  I keep hearing the word, very risky,very risky, from two surgeons. And after a whole year of extreme stress with this multifocal, I just cannot add anymore.
Susan, we seem to be in the same situation.  The only difference is that you keep beating yourself up over this mess, and I keep beating up the doctor that got me into this mess.  Susan, this was not your fault.  I know how it went. The sales pitch was soooo persasive.  See, near, far, and in betweeen. The only down side that was mentioned to me was halos at first around headlights.  Please! Psychedelic world was never mentioned. Circles around everything that reflected was never mentioned.  Nor was the t250 reading glasses mentioned. Nor the constantly changing vision depending upon the lighting. Nor was the fact that a multifocal in the other eye would not be advised.  No Susan.  This was not your fault. All that I needed was monofocals set a bit apart and I could have prevented this whole year of extreme stress. And I still do not know what to do when the other eye becomes impossible to see out of. That eye has now become my dominate eye.  Before the surgery the multifocal eye was my dominate eye.
Susan, put your anger where it belongs, on the doctor whose sales pitch got you into this situation. It was in no way your fault and it is not healthy for you to keep blameing yourself for something that was not your fault.

[aimee37]

The website with the explant video is at www.eyesurgeonsofindiana.com (go to "Doctors Only" then click "Pearls for IOL Exchange."  Dr. Waltz has a "piggyback" technique for doing an explant, which he says is a safer way to do this surgery.

K-D, plano refers to distance vision.  It sounds like your distance vision with your ReZoom lens is very good, but your near/intermediate vision is awful.  If you need +2.50 readers, you're getting no benefit whatsoever from the near and intermediate portions of your ReZoom.  I suggested that you see Dr. Waltz because of his expertise with ReZoom as well as with explanting lenses.  (He has multifocal Arrays, which were the precursors to ReZoom, in his own eyes.)  He should be in an excellent position to make recommendations about your situation.

BTW, it's not true that someone with high myopia would have trouble adjusting to a distance correction of plano.  I had no problem at all.  But for a distance correction with monofocal lenses, leaving one or both eyes a little nearsighted (maybe -.5D to -.75D) gives better near/intermediate vision.

[aimee37]

Thanks so much for the info.  Nice to know that Dr. Waltz is an option. I wish I could access his video, but I have webtv and cannot.  Yes, it is hard to know what advantage I have from a multifocal, when I need t250 readers and cannot see past my wrist when indoors. And all the aberrations that some go through with multifocals. The halos have really, really improved.But it took almost a year. And that may because my cataract eye is now my dominate eye.  When that goes, I don't know what to expect.

[aimee37]

It has been one year since my Rezoom implants. One, I may add, difficult and disruptive year. The first three months were the wait and hope period. They said that my vision will get better after the adjustment period, perhaps there is some inflammation, problems with medication, etc... The next three months were the most difficult in that I had to accept that my vision will not improve and the thought of having these aberrations for the rest of my life was frustrating and frightening.

What bothered me the most was wondering if I would be to cope with this vision ten or twenty years in the future. At this point, I have the emotional and physical strength to deal with this problem, but the idea of having this vision later in life was quite disconcerting.  So, I had two choices..... I could accept my vision and live with it or find a way to resolve this problem.  What I decided was to focus all my energy on researching my options. I wanted to educate myself as much as possible and make the best possible decision. I understood that there would be risks, but I also understood that doing nothing was not an option. I was willing to travel and take the time to find the most qualified person that could help me with my vision. I have found this site to be so informative and I appreciate the contributions made by every participant. In many ways, comments made in this forum helped me to understand that my condition was not unique and I guess I'm most grateful that Dr. Waltz's name was mentioned as a reference. My goal was to find somebody that was very knowledgeable with multifocal lenses and that had vast experience explanting IOLs.

To JMadison's comment, I did not want to be involved with a surgeon who had done only a few explants in their careers. I'm glad I came to terms a while ago and chose to resolve my vision problems. Yes there are risks, but in the hands of a knowledgeable, experienced and skilled surgeon, the risks are minimal.

Susan and K-D, whatever you choose to do, you must think of the future and how your life will be if you do nothing. As we get older, things will become more difficult. I know it is tough, but I suggest that you put all your energy in finding a solution. I had a number of consultations that yielded no results, but I never gave up. I knew it was a matter of time until I found somebody and in your case, if you keep looking, you'll eventually find a qualified surgeon. Please don't let fear prevent you from remaining open to alternative solutions.

[aimee37]

Susan, my myopia before surgery was -4.75 (my non-surgical eye is -5.25).  That is one reason I was so upset with the surgical "correction" of -3.0.  To me, any improvement was virtually nil!  I could not imagine going through life like this if there was a way I could improve it, as I am only 52.   Another reason was I sat in another doctor's waiting area when I was trying to find an explant surgeon, and found myself in the midst of about 5 ladies all about 25-30 years older than myself, all of whom were there for their one-day post op, and they were all talking about how well they were seeing!  I kept thinking that if I didn't do anything I was never going to be like all these older ladies. Also, I am a lefty and my left eye is definitely my dominant eye (the dominant eye is the eye you rely on and is usually the eye you feel most comfortable using for distance correction).  I could not see leaving this eye at the bad result of -3.0 and then having that result influence the target refraction of my other cataract eye; to me, it would then seem that I had two bad surgical results, or to use another analogy, I was pouring more money into a bad investment!

I did not want the doctor who put me in this position to do the explant.  I interviewed 4 other doctors.  Two told me the explant was too risky; I choose a surgeon at a major teaching hospital who told me they had done about 80 explants over their career.  I had to incur significant air and hotel expenses to have the surgery done at this hospital, but I thought going there was my best bet.  I was highly distraught from about one day after the original surgery, when I realized something was wrong, until well after the explant surgery. I would put my despair level only second to that of the death of a family member; I was crying constantly, but I felt I had to act fast to put myself in the best possible position for an explant. I did not know what the outcome would be, but I felt I had to act.  For me, I did what I could to mitigate a bad situation. I'm relieved that I have had a reasonable surgical result of -0.5, but I wish I had never gone through the hellishness of the past few months; the emotional cost was too high.

My main problem now is that one eye is -0.5 and the other eye is -5.25.  Because of this visual dissonance, I feel I have to wear a contact in my surgical eye all the time. I'm torn between going on like this or having my other eye corrected.  Right now, I'm not eager to go through any more eye surgery.

Blue, you have my best wishes for a successful outcome. I very much relate to your post about how you came to your decision.  I wanted to post about my experience just because I would have liked to have read about someone else's exchange experience prior to my surgery.  Please post about your outcome.  

[aimee37]

Edit to third paragraph above:  I wear the contact in my NON-surgical eye.

[aimee37]

Thanks for your kind words of encouragement. I appreciate them very much. And they have given me much to think about.

[aimee37]

Jodie,  thanks for the URL for the video on the IOL exchange.  That was one creepy video, how can anyone stand to be an eye surgeon?  You'd definitely need steady hands and nerves of steel.   No wonder they have such big egos!

Jmadison, I don't see how you can stand to be that unbalanced, -0.5 in one eye and -5.25 in the other.  You were actually planning to be this way before surgery, ASKED to be "plano" in just one eye? I would think the -3.00 plus -5.25 would be MUCH easier to adapt to than what you did.  When you're used to being nearsighted, suddenly not being is VERY difficult, at least it was for me.  When you're nearsighted you can simply take your glasses off to see something close, when you're farsighted you can't see anything close at all without finding your reading glasses.  Of course you're wearing a contact, but my eyes have been so dry since surgery that is something I would never consider.

K-D, I do blame myself more than my doctor because he didn't talk me into anything, I went to him specifically because I wanted multifocals.  (Or thought I did.  Obviously he should have told me more of the risks, but considering how new they are and how Alcon probably lied about their test results he probably didn't even know all the things that could go wrong.)   And yes, there's no getting around it, an exchange is MUCH more dangerous than a plain cataract surgery.  And even if it weren't,  NO doctor has had a fraction as much experience with exchanges as with regular surgery.  My new doctor says he's done "hundreds" of IOL exchanges, but really that's nothing, he's probably done hundreds of thousands of plain cataract surgeries.  If he did only 20 a week over the 30 or so years he's been practicing that's 30,000 surgeries!

Susan12345

[aimee37]

Blue92, I really admire the wisdom of your philosophy and your follow-through.  You impress me as someone who makes his own good luck.  If you exercise a similar way of thinking/acting in your personal and work life, you are probably a very successful man.

Susan, I think there's a lot of truth in some of your statements.  Cataract surgeons probably were accustomed to having satisfied patients, and that probably did change to some extent when they began implanting the new multifocal/accomodating lenses.  And you're right, too, that the surgeons relied on the manufacturers for information about the anticipated outcome, contraindications and potential complications of these new lenses. (Where else could they obtain it from?)  Probably most surgeons relied on a manufacturer's rep, who got his/her information from corporate headquarters.  But, even so, getting multifocal lenses was NOT an absurd choice on your part, even though your outcome was so much less than you anticipated. (I probably would have made the same choice if I didn't have a slightly damaged retina.)  Many people are very pleased with their multifocals.  In an earlier thread, there's a recent post from k0k0 (2/2/07), who loves the vision that ReZoom/ReStor provides.

Psychologically speaking, it seems that when a risk is quantified (e.g., a 1 percent risk of retinal detachment), it becomes SO much more significant in our thinking. I totally agree with blue92's advice for those facing the dilemma of what to do next:  Don't let fear prevent you from considering all of your alternatives.  Doing nothing also involves (unquantified yet significant) risk.        

[aimee37]

Susan, my plan was DEFINITELY NOT to be this unbalanced.  My plan was to have the first eye done at plano, then based on that result to decide to have the second eye done shortly afterwards also at plano or possibly monovision.  Based on my own personal view of living with -3.0 for a month, I would never ever choose it as a monovision target. I found -3 and its tiny range of vision extremely unsatisfactory.

My plan was aborted after my unfortunate first surgical experience and subsequent exchange. I now feel that I need some downtime to replenish my emotional reserves before going through this experience again with my other eye (I am just now in my 11th week after starting this cataract odyssey). Hopefully, when I do have my second eye done, I will be in the vast majority of satisfied cataract patients who have a reasonable result.  

Having such eye disparity is NOT FUN and does give me some concern, but I view it as temporarily the lesser of two evils.  I also need some time to think about what result I would like in my second eye given that my dominant eye is -0.5. My thinking is I would be much more pleased if my dominant eye were plano, then I would aim for a slight monovision of -1.0 with my weaker eye.  Now, given that one eye still needs a modest correction, I don't know if I want to target plano for the other eye or a very slight monovision. The place I went to for the exchange told me that 90% of the time they are within .25 diopter of target, the remaining 10% are within 1.0 diopter.  After having two tries, I would like just once to fall in the 90%!

[aimee37]

But aren't you basically at monovision now?  I thought monovision was one eye corrected for distance and one for near, am I wrong about that?   Of course , assuming you still have a cataract in your non operated eye it would hopefully be better after surgery, but if both your eyes are corrected for distance and you're using to being nearsighted it may be hard to adapt.  Though of course you're already wearing a contact in your non-operated eye, so I guess you must be able to adapt. Good luck on your next surgery.   Susan12345

[aimee37]

Jodie, Rereading I see that you didn't have trouble going from myopia to plano.  How on earth did you make that adaption?  I was used to wearing reading glasses for reading, but it drives me nuts to no longer be able to do stuff like read the microwave buttons without my reading glasses.    Susan12345

[aimee37]

Before cataract surgery, I wore toric contacts corrected to plano.  I had progressive glasses for near/intermediate vision.  Cataract surgery gave me the same vision I used to have with my contacts, so I had no problem adjusting.  (BTW, this was not what my surgeon and I had planned.  The target had been -.5D for both eyes, which would have given me better near/intemediate vision, but things did not end up exactly as planned.)

When I used to do monovision with toric contacts, my right (dominant) eye was corrected to plano, and my left eye was corrected to -2D.  This gave me excellent near and intermediate vision, and very good distance vision.  Sometimes I wore glasses (over my contacts) with a -2D corretion in my lett eye for watching movies and driving at night.  (Without a toric contact, my left eye was -5.50D with about 1.5D of astigmatism--WAY too nearsighted for monovision.)



      

[aimee37]

So monovision is actually only a difference of 2.00?   For some reason I thought it was a lot more than that.  Could you actually read without glasses with that small a prescription?  Since my reading glasses are +2.50, it seems like I'd need at least that.  And that's added on to a prescription of  + 1.00 for my right eye, so really +3.50.  Not that I'd have any expectation of not wearing glasses if I had an IOL exchange, just trying to figure out how much difference I could tolerate with glasses and still be able to slip off my glasses and read a sentence or two.  Susan12345