ReZoom Lens - Will It Work with a Patient with Limited Pupil Dilation?

Would someone with a pupil abnormality (limited dilation due to childhood trauma) be a candidate for the ReZoom lens?

[Forum-OD-MP]

it depends on the circumstances.  
if your ciliary muscle is still funtional, and your pupil is fairly round, and you have not already had cataract extraction (from the trauma) then yes, its still a possibility...

[eyecu]

The central portion of the ReZoom lens, which is 2.1 mm allows for distance focus. The second zone which goes from 2.1 to around 3.4mm is near, the third zone is distance. You would want your pupil to dilate greater than 2.2mm in ordering to get the full effect and bring in the near zone for reading. You can get your doc to check your pupil size in the lane by varying light and measuring it under different ligthing conditions to see how you would fair. If not, I would opt for the Tecnis monofocal if you need cataract surgery.

[nursept]

I was dx'd with cataracts bilat.  I am 43 y old, no family hx
I am interviewing surgeons at this time and researching the issue.  I can no longer drive at night and depth perception is poor.  HX of R. eye Ret. detach 1978. Myoptic 5.00 bilat (however, nothing is helping the L eye now).I have looked at info regarding silicone vs. acrylic.  I extruded my silicone from the RD and it was removed in 2000. Thus, I am concerned about the kind of foreign material  in my eye as well as RD risks (8% over 10 years I am told). What is recommended thus far: Rezoom lens Acrylic. I was interested in the info re: pupil dilation size and the relationship to success with this lens.  I read music and drive so intermed and distance important to me.  I am a nurse so I think about all the complications of any surgical procedure.  With the HX presented, what is your opinion on acrylic vs. silicone, ReZoom lens(heard halos and glare a problem), acrylic hydrophobic,
post. capsule opacification (40% in younger patients?)I do not have many choices as I am getting more homebound every week.  These Cataracts developed in 2 years.  Visual disturbances started 2 years ago, but 5 MD's could not find anything wrong.
In the last 6 months they finally saw the defect. If I am that sensitive to optical changes, will the REzoom lens annoy me with all it's little visual prisms?

[eyecu]

Silicone versus acrlyic is a matter of preferecne and debate. My uncle is a 5 diopter myope and had bilateral silicone Array lenses. He did have a capsular tear in the 2nd eye and had a RD a few weeks later. They got to it in time and he ended up with a scleral buckle which does throw his refraction off some but he is happy and still an active golfer. Your case is different because you already had a RD and have had silicone oil used. I would go with acrylic. Silicone oil can adhere to anything but it will adhere to a silicone lens the most. The ReZoom meets your criteria and has a special edge that deters posterior capsule opacification. Usually all lenses get PCO and it is easily taken care of with a YAG laser. You might be at higher risk due to any disruption of the vitreous face but you really don't have much choice. The tecniques today and the equipment is much better and at your age your lens should be pretty soft and easy to extract. You actually would do well with the ReZoom with what you are looking for. All multifocal lenses will give you some halo but the brain adapts and the benefits over ride the downside of the visual symptoms. If you are really concerned go with a monofocal and wears readers. The other thing is that the younger you are, the quicker you seem to adapt.  Make sure your doc has experience with the lenses and you should be fine.

[nursept]

Thanks so much for the information.  A physician can say a lot of things like he/she has a lot of experience with this or that. Call me skeptical but I know, I used to   be a Pharm sales rep. Would the best approach be to contact AMOS (who makes ReZoom)?  Perhaps they can tell me who in the area has a lot of experience w/ this lens
type?  Thanks again you were very helpful.

[eyecu]

Go to www.visioninfocus.com which is an AMO website that you can go through and answer some questions to help determine what is right for you. There is a find a doctor spot on it which when you type in your zip code will tell you who the certified ReZoom surgeons are in your area.

[nursept]

Thanks so much.

[nursept]

I was able to speak to the ReZoom sales rep myself and he answered a lot of questions. Halos are quoted at an average of 5-6 % but of course everyone is different.  I have browsed the many comments on Restor vs. Rezoom lens.  It appears there are more negative comments re: Restor than Rezoom .  Have they been out the same length of time?  I am in the process of deciding which one to use. The most important thing to me is CLEAR vision.  Wearing contacts to correct my vision after surgery is not offensive to me.  I do not want" a little blurry vision all the time" as I have read on one of the comments re: Restor lens. My presbyopia is not too bad yet and I am not opposed to wearing bifocal contacts if necessary.  Distance and intermediate vision is important at this point.  I would be interested in your opinion regarding the lens type

[eyecu]

Distance and intermediate and clear vision is what the ReZoom will provide you due to optics design. It should not be blurry. This lens uses 100% of the light and the other loses some due to diffraction. That is why you have heard about the complaints. They have both been out the same amount of time but the ReZoom is an improvment on the Array which has been implanted in the US for over 7 years so it is true second generation. A monofocal will give you crisp clean vision and clear vision because all the light focuses on one point. But you do not have the benefits of near and intermediate unless you try monovision which some patients cannot tolerate, me included. I tried it with contacts and lasted about two hours. So there are trade offs as there are with many things in life. You get the added benefits of near and intermediate but will have to deal with some halo effects which can be diminished as you adjust over time. One doc equated it to putting a ring on your finger. At first, you feel it and know it is there but you adjust over time or listening to a new clock chime. At first it wakes you up but over time you do not even conscioulsy hear it. You also get into pupil size, occupation and hobbies etc. Some feel the ReZoom is better for younger and more active patients and the ReStor for more sedentary  patients who read a lot. If you perform a lot of intermediate tasks such as working a cash register or using a computer than you would receive a ReZoom. Obviously there is no 100% perfect answer just like some drugs that work great have side effects you have to deal with and it depends if you can putup with the side effects. Of course, you can stop taking the drugs and you can also have the lens removed but the latter is obviously a more troublesome thought. Your attitude also has a lot to do with it. If you want it to work and are postive about it, you will probably have better results. The one thing you have going for you is that you are young and the young seems to adapt the best.

[hud]

you're missing the boat on ReSTOR. When most of the FDA study patients never need glasses again, and MOST of the Rezoom FDA patients do, there a big reason. Life is at all distances- I chose  the best chance of never needing glasses for ANY activity. This computer looks fine. Get a second, third, fourth, or fifth opinion. It's worth it for this once in a lifetime decision.

[Eagle eyes]

How can you, (HUD) say that most ReZoom patients need glasses. The data I saw states that 93% of ReZoom patients go without glasses for distance and internediate and 92% for near. That is 9 out of 10 patients.

[Eagle eyes]

As for getting 2nd, 3rd opinions, I definitely agree. It is worth mentioning though that these opinions should be by a doctor that does both ReSTOR and ReZoom, otherwise it is probably biased.

[hud]

see the FDA labelling- not the marketing propaganda. I don't remember the link to find it, but Rezoom submitted array data, not rezoom, for approval. The "never" number was 41%; what you saw was combined"never or occassionally" wear glasses. Before my surgery, I was 100% never or occassionally wearing glasses. The Restor "never" number was 80%. What does never mean to you? The problem with finding drs. that do both Rezoom and Restor is that some don't want to turn any "customer" away. But if most do Restor, and few do rezoom, the jury is in, in my opinion.

[nursept]

Well, this Restor/Rezoom issue certainly sparked some chatter!
I like to look at clinicals AND field results.
Hearing from patients who actually USE one or the other would be most helpful as well as physicians who use both lenses to see what their patients are telling them. (I also suggested to the company that having a contact lens that would simulate the kind of vision and halos one might experience would be helpful.) It appears to be a balanced approach- to hear all sides. Also, I am quite aware that individual patients' needs must be taken into account. I am also interested in lens design-specifically the edges of the lens- does one help to discourage PCO more than the other?   All your comments are very helpful.  Thanks.

[Eagle eyes]

At this point, there are more MDs using ReSTOR than ReZoom. There are also more unhappy ReSTOR patients than ReZoom patients as well. Ask the surgeons that are doing both ReSTOR and ReZoom and let the record speak for itself. As for PCO, square posterior edge design is the key to lower Yag rates. Both ReSTOR and ReZoom have square posterior edge for 360* contact with the posterior capsule. Both ReSTOR and ReZoom are excellent products. The key is matching the lifestyle, visual needs, and visual desires with the lens. When one has a thorough understanding of the design of each product, it is clear to decide which lens will work better. Look at lifestyle, occupation, hobbies, pupil size, and how the lighting while these tasks are performed. Example: If one is outside all day in bright light, NEVER is on computer or cell phone, doesn't shop, golf, hunt, paint, cook, and enjoys very close reading ReSTOR is an excellent choice. If the above ntermediate tasks are important as well as excellent distance vision which is automatically desired, then ReZoom is the way to go. ReZoom also gives great near vision in low light scenarios such as restaurant at night, movie theatre, etc. In bright lights, ReZoom gives adequate/ good near vision. Plus when my surgeon has a compromise in surgery, ReZoom can be placed in front of the bag.

[nursept]

To Eyecu:  If I decide to use the ReZoom IOL, if the vision is alittle blurry, can I get contacts to correct it?  Also, I heard the lens works better if it is placed in both eyes.  I will have to have both eyes done, so is that true?  They were scheduling the R eye to be done 4 weeks after the Left.  The R. eye is getting worse but I wanted to try and see how the ReZoom settled into my L eye and how the halos look before putting both in.  IYO what would you do? In your practice, what have you seen work best for your patients?  THanks

[cataract49]

I am now scheduled for surgery in 9 days. With much research, I have selected the ReZoom for the first eye. I have been wearing contacts for over 32 years and rarely wear glasses. At 49, I have been wearing multifocal contacts for the last two years.
My thoughts are to install the ReZoom in the first eye which has a very bad cataract at this point. The second (and dominant eye) is only slightly effected by a cataract.

Although my surgeon is recommending the second eye surgery, and has it scheduled for 4 weeks after the first eye, I am interested in seeing the results of one eye w/ReZoom and the second with the multfocal contact lens. My surgeon is stating that if my theory is working after the first eye is done, then we can always cancel the second eye surgery until such time that it's cataract worsens.

Does anyone out there have experience or thoughts with this situation?
(one eye multifocal IOL/ one eye multifocal contact).

[Eagle eyes]

Hi Cataract49

Yes....WIth any cataract surgery (Even with standard intraocular lenses, the two eyes work better together when matched or both eyes done. This is why your surgeon is recommending this. He is right though, if you tolerate the CL in the non-operated after ReZoom in 1st eye, you can postpone the surgery on 2nd eye until you want. It is elective and won't hurt anything to wait. With that said, I think you will find that you will be eager to have 2nd eye done sooner rather than later. Multifocal IOL is not equally compared to multifocal contact lens in that the contact is on the external eye and therefore other factors can affect vision (dry eye, movement of contact, fit of contact, allegies, etc.) Best of Luck,,,let me know how you do!

[cataract49]

Thanks Eagle Eyes;

I will post after surgery with results.

For Nursept, my extensive reasearch has pointed me to the ReZoom. Like you I am still very active in my career and plan to work for some years to come.

My thoughts are that I want good distance, better low light vision, good intermediate, and if I end up wearing reading glasses then at least 95% of the time I will be without glasses.

As per the halo possibility, my multifocal contacts now give me a halo at night with lights, but i do not even realize it.

Although it may not be true for everyone, for me the ReZoom seems to make the most sense.

My only trepidation is that my surgeon (very experienced at cataract and lasik surgery) has calculated the correct power of my lens. He is telling me that there is some chance that I may not get 20/20 at distance initially, but if that occurs then he can easily fine tune with the laser.

Eagle Eyes; Any thoughts on how long I must wait to do the lasik if fine tuning is needed? Or am I better off to correct with contacts?

[Eagle eyes]

HI Cataract49

Well, if your surgeon is doing LASIK by creating a flap, he will probably wait at least 2-3 (prob 3 mos) or so. If with IntraLase where there is no flap made, it can be done sooner. Wait and see how things are after surgery. You should be able to go back to contact lenses if you want. By telling you this up front, it gives you realistic expectations that so you don't expect "perfect" vision, especially immediately following the surgery. Keep me posted.

[nursept]

Cataract 49 and Eagle Eyes: Thanks so much for your information.It is a big decision.  Eagle eyes: Do/did you have cataracts yourself?  Which lens do you have? Cataract 49 please keep us posted on your progress.  I am not planning surg. until Feb/March.  Thanks again

[eyecu]

nursept: sorry for the delay in gettng back with you. I really do not think you have to worry about your vision being blurry. The ReZoom is designed to get you 20/20 distance. Some surgeons do surgery one to two weeks after the first eye and some wait. I think you will be fine. Go in with a positive attitude. There are even patients who had the Array lens and came in two years later to have their second eye done and did just fine. It is your call. You might even decide you want it done earlier. This tecnology just keeps getting better. Trust your surgeon. You might have halos bother you some at first and you might not. The brain adapts and the younger adapt quicker. Some even find it overstated as they have had side effects anyway during their life and have adapted to them. Let us know how you do.

[nursept]

EyeCu: Thanks.  I am scheduled to see Surgeon #3 in 2 weeks for his ideas on the subject.  He did the initial studies on ARRAY and has opted NOT to use the new gen. REZOOM.  I want to know why.  He uses ReStor.  My  understanding is that currently, there is NO accommodating lenses out there, is that correct? Everyone just gets your RX as close as they can and then adjustments are made with either Lasix/Lasex or glasses/contacts. Sorry I sound alittle negative.  After 5 MD's in 2 years who could not figure out my problem, I am alittle discouraged with the whole process.  Educating myself helps me deal w/ it all and then take responsibility for my decision-whatever the outcome. I will keep you posted on what I choose and my progress.  THanks for donating your time to this forum.  It is very helpful.

[Eagle eyes]

HI Nursept,

I do have a cataract in one eye and coming on the other soon I am told so I didn't have surgery yet. I also had RK done years ago, so for me it gets complicated as to which lens is the best and which surgeon to go. After you have had LASIK,RK,or PRK it makes the cataract surgery more challenging to select the correct power of the IOL (Intra-Ocular Lens). Because I am a nurse and work in this field by talking to our patients that have received all types of IOLs, regular monofocal, Tecnis monofocal, ReSTOR in both eyes, ReZoom in both eyes, Crystalens in both eyes, and combinations of mixing and matching all of the above, I get a nice view of what works best and when. How fortunate for me!

[Eagle eyes]

Nursept

When you see your doctor in a few weeks, let me make sure I understand the situation. He was the one that did the Array initially and then stopped and now uses ReSTOR only right? If that is the case, definitely ask him why he doesn't use ReZoom.
FYI, when the Array first came out, 1. we did not have as good of technology to do the measurements for the IOL so it was more challenging to pick the right lens and this is huge for the success of all of these new lenses. 2. we didn't understand that the brain has to get accustomed to the new vision (now called neuro-adaptation or cortical summation) These are big words that mean the brain has to get used to the new vision. This occurs with all of these new lenses (ReZoom, ReSTOR, and Crystalens.) 3. If he were to try ReZoom today if he is having success with ReSTOR, he will love ReZoom, I guarantee. The new technology that assists him to have success with ReSTOR will do the same for ReZoom. Plus both ReSTOR & ReZoom have much less halos/glare than Array. The one that seems the easier for most people to adjust to is ReZoom. Keep us posted.

[cataract49]

Nursept;

I will post next weekend if I can. My surgery is scheduled next Friday. Like you I am a -5.5 myopia in the first eye to be operated on. It is also my non-dominant eye. My left eye is a
-7.5 myopia an I have no Astigmatism to deal with.

I must admit I am a little nervous and you are correct in stating that this is a big decision. Chosing the right lens is important. If it is any comfort to you, I have been following the progress of and researching these lens for well over 8 months now. I am very comfortable with my choice of the ReZoom and I am now to the point where I can not wait any longer as my cloudy vision is effecting my daily activities.

Good luck in your decision and subsequent surgery.

[nursept]

To all:  Thanks for your comments.  Cataract49- we are looking forward to a good report!  Eagle Eyes: thanks for your input. I DO intend to have a dialogue w/ him re: why he sticks w/ ReStor lens.  I spoke also, w/ a surgical instrument company educator and they leaned toward the ReStor lens vs. ReZoom.They do  not sell either lens.  They have heard MD's and patients discuss their results w/ both lenses.  Everybody has an opinion, huh?
I found out only the Crystalens accommodates but it is only good for lower powers. (myopia)

[bjbinfl]

I hope this response is not too late.  I just got a rezoom lens implant in my left eye last Monday.  I LOVE the distance vision.  I have not seen this well for years!!!  My close up vision with it is not great, but it is gradually improving.   I am wearing my contact lens in my right eye and am having no trouble whatsoever using the two together.  I was planning on having both eyes operated on, but now, I am going to postpone the right for the time being.  I think if you are willing to make the adjustment you should do fine with a contact in one eye and the rezoom in the other.

[eyecu]

I am happy for you. Give your near some time. It has been only 6 days for you and you usually have a little corneal edema after surgery. Everyone tends to forget that they have had major surgery after eye surgery because it does not take that long for the procedure. But it is invasive even thought minimally. You are probably still on a steriod like Pred Forte and are tapering off your antibiotic drops. The near vision comes in more gradually as you heal and adjust.

[cataract49]

Bjbinfl;

Glad to hear things went well. Would you be able to share some info like; were you nearsighted or farsighted? Do you know your diopter pre surgery? Did you have any astigmatism?
Did you need reading glasses prior to surgery?

Are you wearing a standard contact in the other eye?

Any info you would like to share would be welcome.

[nursept]

To Bjbinfl: Thanks for the good report. How is your intermediate vision?  Is it as good as your distance?  Thanks for posting. To EyeCu:  I was told it is not a good idea to wear contacts in the "cat. surg. eye" even after the month of healing due to increased risk of infection.  Is this true?  I am asking because if they don't hit the mark on  your distance or near vision, I thought a person could wear contacts on the "surg" eye after the IOL implant- if a person did not want Lasik/Lasex .  Is any of this true?  Thanks.

[bjbinfl]

Okay, a couple of you asked for more information.  Here goes:
Before my Rezoom lens implant in my left eye, I was nearsighted since childhood.  I am now 61.  I wore contact lenses most of my adult life.  For the last ten years, reading with contacts became increasingly difficult and bifocal contact lenses never really worked for me, so I got used to monovision, using my left eye without a lens for reading and my right eye for distance with a contact lens.  In the last year, my left eye became increasingly useless as the cataract developed.  I could no longer see far or close with my left eye and I was needing more and more light.  So, I was using my right eye for virtually everything.  If I did not have my contact in, I could read with it, but if I wore it for distance, I needed reading glasses.  I was hoping that the Rezoom lens would help me see far and near.  I have seen my opthomologist twice since the surgery.  He is a wonderful doctor and I have a great deal of confidence in him.  Apparently, my pupil is not opening enough at this point to enable good close vision.  When you ask about intermediate vision, I am not sure what you mean...I cannot see the computer easily and I sit about 1.5 feet away from it.  But, if something If I move about 3 feet away from it I can read, but it is a little fuzzy.  The doctor said he will do whatever it takes to make sure I have the best vision possible.  Right now, he is watching it...yes, I am taking the pred medicine right now and I no longer take the antibiotics.  I feel very happy with the distance vision this provides and would not want to compromise this by getting a different lens that would help me see close but not so well far.  For now, the contact lens in my right eye is working out with the IOL in the left eye.  I have no idea what would happen if I put a lens on the left eye, nor would I be interested in trying one.  Maybe others know something I do not, if so, please let me know.  One more thing...I never realized how white my kitchen cabinets are...I see color so much better and there is a difference in my right eye...things look like they are a bit brownish yellow with that eye but nice and clear with the left eye!!!  Very exciting.  Also, I have no glare at night.

[bjbinfl]

Forgot to mention.  I had a mild astigmatism in the left eye prior to the lens implant.  The Doctor corrected this during the surgery by making small incisions in the eye.

[eyecu]

Trust what your doc said. You do not want to wear a contact on the surgical eye. It takes time to heal and you should not need it anyway. The correction would be in the nonoperated eye to bring them both into focus if need be. The measuring of the eye, the newer formulas used and astigmatic correction are more accurate today and more hit the mark than miss.

The ReZoom eye should continue to get better and adjust. Pupil size is important for near and you might still have some miosis after surgery which is keeping it restricted. It sounds like your surgeon knows what he is doing. You can also turn the lights down to enlarge the pupil and find out that reading is better. Instead of a 100 watt bulb use a 60 watt if need be. You are still just out of the shoots and everything should still improve.

[bjbinfl]

Thanks for the support.  This is a wonderful service.

[Eagle eyes]

BJBINFL
GOod for you. Suggestion on the small pupil that may be affecting your near or up close vision. Have your MD on next visit, test your near vision with no correction and measure it. Then dilate your pupil with a short acting dilating drop like Mydiacyl!% or New-Synephrine 2.5% (he will have these in the office). then test your near vision same as before. If you notice dramatic difference then he could do a pupil repair with the argon laser (very simple procedure) We have done this on our patients in this scenario. If you have astigmatism (eye like football instead of baseball) this also cause near vision to be blurry. That can be fixed too.
Yes waiting on Contact lens until eye heals is best.

Let us know.....

[cataract49]

My ReZoom surgery went extremely well yesterday. The procedure itself went very smoothly and the improvements to my vision were wonderful. I was able to insert my multifocal contact in the non surgery eye shortly after. Yesterday my vision was good but I did have some fuzziness to my vision at all distances (surgical eye), which my surgical team told me I should expect.

One of the surgical team commented that starting today expect improvements as the eye heals from the trauma of surgery.

Upon waking this morning, I was very pleasantly surprised to have EXCELLENT vision at distance. Even with my contact corrected eye my distance hasn't been this crisp for some years now.

I just returned from my post op check up where my doctor was himself just amazed at how well I am progressing less than one day post op.

My distance is 20/20 and I am reading down to J1 (the smallest print) at 14 inches!!!!!

I am seeing the computer screen very clearly as I type this posting.

My surgery was done yesterday afternoon and my night vision was OK. I did NOT see halos when looking directly at lights last night but I could see the optical rings from my peripheral vision. As I focused on distance and then focused in on closer objects the rings would appear in a stepping stone fashion. I was not bothered by the rings and I am convinced that they will diminish as they did get better as the night went on. It was interesting the way they occur though as they appear and then get larger in steps. I knew I was actually seeing each ring as my brain changed focus. Already today (as I stated above) my vision is much crisper and in dark rooms the rings are not appearing.


Nursept: I can tell you in confidence that I already consider my surgery a success.

Today the weather is sunny, with a bright blue sky, and I am seeing things better than I have in years! It is almost as if the weather has cooperated to try out my new vision system!

Good luck and if I can answer any more questions, just ask.

[nursept]

Cataract49: I am so happy for you! You've ALMOST got me excited to have surgery! LOL I cannot wait to see clearly again, after 2 years of blurry, halo vision. Thanks for being so specific about the rings you are seeing now.  I guess those disturbances kind of go away or a person adjusts to them.  Perhaps the MD can comment on that. Please continue to post and tell us of your progress as you heal.  Thanks for letting us all know how you did.  

[nursept]

Cataract49- forgot to ask, did your surgeon test your pupil dilation prior to surg?  With the great vision you are having you might have to change your name to "Cataract29"  LOL.

[cataract49]

Nursept;

I did not have my pupils measured prior to surgery. My surgeon did measure my eye dimensions twice (6 weeks apart) to get accurate numbers for the lens power selection.

Last night I went to a restaurant and can read fine. In the place I was, the multiple light bulbs on the ceiling did trigger halo rings but only from the right peripheral vision. As I stated previously the rings jump and because of the multiple lights, I was experiencing an interesting light show with any movement of my head.

I am starting to wonder if my ReZoom lens may be just a tiny bit off center. I will have that checked on my next visit this week.

Anyone else have this type of halo effect (not when looking directly at lights but when the lights are of to the side-my right side of my right eye only)?

[bjbinfl]

I had my lens implant two weeks ago.  The halo effect is gone.  It took about a week for me.  I love my distance vision, but my close vision is still blurry.  My doctor feels that my astigmatism is the problem.  I have another check in a week.  At that time, he will determine if a correction on the astigmatism is necessary.  I am holding off having my right eye done until the left one is the way it should be with the rezoom lens.