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Anyone else adapted to Lentis Mplus lens after two months?
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Anyone else adapted to Lentis Mplus lens after two months?

I originally posted this as a reply to another thread but thought I'd start my own as I'd like to get some opinions.   I had the Lentis M Plus lens implanted into my right eye 6 weeks ago.  The left eye implant that was planned for a week later was postponed indefinitely as I had massive ghosting/double vision and glare in the right, which caused me enormous distress and concern.  I have since had two other checkups, one was unscheduled as I was so worried, and my one month post-op was l2 weeks ago.  I was convinced that the lens was decentred but the optometrists say it’s perfectly centred.  It feels like I’m forcing my eye to see distance through the close up part of the lens.

I won’t name the clinic yet as I’m undecided whether I’m happy with them or not.  I’m trying to convince myself it’s getting better (but I don't think it is) so I’m keeping an open mind for now.  It’s only been 6 weeks, but they are easily the longest 6 weeks of my life!  As things stand, if my left eye had been done after a week and had the same effect, I would be almost housebound, I certainty would not have been able to drive.   I’m only a young 53, so I’m glad I still have a good untouched left eye (with a contact lens).

I have been assured that the eye/lens will “settle” and my brain will adapt, so I guess only time will tell.  The clinic will happily explant the Mplus lens (so they say) and replace with a monovision lens, but that really defeats the whole exercise, so I do want this to work.

Has anyone had experience of these bifocal type lenses being de-centred and re-positioned?  if not, I’d love to hear from anyone who had the same ghosting/blurred vision which lasted at least 5-6 weeks then cleared.

Anyone tried exercises to help with Neuroadaptation?  This company in the US will happily sell me their program for $500… http://www.revitalvision.com/
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Sorry, what does "-" mean?
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It maans I've read the post previous post and have no further comments.
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Oh.  So does that mean the thread is closed?
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hankhill, here is an article from CRSToday Europe where a a decentration of the lens is mentioned by a Doctor:

http://bmctoday.net/crstodayeurope/2010/05/supplement/article.asp?f=the-only-presbyopia-lens-with-hd-vision

"Auffarth: Since we have adequately outlined the strengths of the lens, I will discuss what could be seen as weaknesses. If you look at the patients in whom we encountered some problems, you will notice that they are all surgically related and not due to the lens itself. In one case, the lens was slightly decentered upward, and the patient looked through the near part in the distance. I had to explant the lens, but it was due to the off-centered rhexis."


Out of interest, do you have the +3.0D or the +1.5D MPlus?
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Avatar_m_tn
Thanks for the reply.  Very interesting that you should ask.  I had the add 3.0 - "standard Mplus".  By coincidence, only yesterday I met a surgeon that I had been referred to by OE for a second opinion.  After tests he said the lens was not decentrated nor tilted and that I was just one of the unlucky few that just did not adapt to it, and probably never would.  (The conspiracy theorist in me thinks that the lens is indeed decentrated, but nobody wants to confess to it.  I'm sure that's not the case...)

Instead of recommending explantation with a monofocal, he has suggested the newer Lentis Comfort; is that the add 1.5 version that you are referring to?  I was a bit surprised, but also glad as I may still retain some good reading vision with that option.  I did ask if it’s the same basic design as the Mplus, then won't I suffer the same problem (bad ghosting mainly), but I was assured that I very likely wouldn’t.

I now have to make the decision whether to swap my Mplus for the Comfort, or for a standard monofocal.  The Comfort lens is newer than the Mplus but seems very similar (which worries me), and there is very little data or feedback on the web about it, other than numerous manufacturer site links.  Anyone have any experience with this lens or any opinions to share?  I have seen a positive post here by Londonfreda but I’d love to hear from someone that had problems with a premier multifocal IOL like the Mplus, and subsequently tried the Lentis Comfort.

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hankhill there are actually two Lentis Mplus models/strengths in addtition to the Lentis Comfort:

* LS-312 MF30 - Has a +3.0D section for near focus around 30-40cm.

* LS-312 MF15  - This has a +1.5D section for intermediate focus.

Does your ghosting look like watching a 3D movie without the glasses on?



I had not read much about the Comfort but looking at the picture of it it also appears to have a similar (possibly less prominent) second zone at the bottom and the website mentions its intermediate ability. Interestingly they don't list it in the "premium" lens range yet it isn't a monofocal.

You can download pdfs and data sheets on all these lenses from the manufacturer site http://www.oculentis.com


In this CRSToday article there is a brief discussion of using (or exchanging a 1.5D Mplus in the second eye for patients not adapting to the 3.0D (P. 10,11):

http://www.oculentis.com/Press/press-CRSToday-Supplement-012012-EN.pdf


Also this from another CRSToday article:

"The Lentis Mplus is also a fantastic lens, and the low near add model (1.50 D) might be a universal lens for any patient because of the improved intermediate vision and short neural adaptation process, which are clear advantages over monofocal lenses."
http://bmctoday.net/crstodayeurope/2013/01/article.asp?f=state-of-the-premium-iol-market-in-europe

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Hi,
Firstly I really appreciate your replies.  Are you a surgeon?

You must be psychic – the surgeon that made the remarks in the paper you refer to, Prof Jan Venter, is actually THE surgeon who implanted my Mplus IOL.  I have no issues with his ability as a surgeon (at least not at this stage) although unfortunately he works for a company that is very much a high volume money making machine, and so my direct contact with him has been limited to two 2-minute meetings.  It will be a discussion point, but as things stand I wouldn’t have any issue with him doing my explantation.

Yes, the ghosting I have is similar to 3D TV without glasses; although a bit less less so, and it does vary depending upon the light level. In bright outdoor light the ghosting is mainly seen at distinct contract boundaries, eg, rooftops, tree branches, against a bright sky.  Indoors, it’s more general and leads to an overall blurring (presumably because my pupil is larger and a larger part of the low add portion is exposed), but is especially noticeable on lights, the edges of TV and computer screens, TV subtitles, anywhere there is a district contract edge or bright light source.

I am still convinced that my problems are mainly due to the position of the lens in my eye, rather than my lack of ability to adapt, although I’m obviously not a surgeon and two independent surgeons now have told me that I’m just unlucky and the lens placement is fine.

My big concern now is this - I have looked on the manufacturers and distributors websites, and it’s hard to tell exactly what the difference is between an Oculentis Mplus lens with 1.5 add, and a Comfort lens with 1.5 add.  As far as I can tell from the specifications, unless I have missed something, they are one and the same; and my concern is that if I am indeed one of the “unlucky ones” that doesn’t adapt to a lens of this type, will I be in the same position (only maybe slightly less so) if I explant the 3.0 add and implant a 1.5 add?
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Hi hankhill,

No I'm not a doctor, just another middle-aged cataract sufferer like yourself (in my 40's).

Firstly, I have since found out that the 1.5D Lentis MPlus is in fact the Lentis Comfort - they have the exact same product code and my Opth says it was first released as the MPlus 1.5D but is now branded as the Comfort. The company probably wants to differentiate the lens to the intermediate/accommodating market segment.


Secondly, you might be interested in my own situation as it somewhat mirrors yours (please forgive the very long post):

I had an MPlus +3.0D put in 4 weeks ago in my left (inferior) eye and suffered the same kind of visual symptoms for distance vision that you did - double vision/ghosting in the daytime and reflections under lights at night (not full halos - these were only under the lights - like half moon shapes).

These under-reflections at night were still better than the large 360 degree starbursts I was getting from the cataract in my right (dominant) eye. Also, the cataract starburst increased as car headlights got closer, whereas the Mplus reflections got smaller, so overall while not perfect it was an improvement on what I had with two cataracts and I was able to drive at night without sunglasses and the sunshade down for the first time in months (cue Blues Bros soundtrack).

It was still pretty disconcerting though to see big "smiley" faced reflections under every traffic light and car headlight (they were especially big at 200m+), and I remained hopeful that like many others I could adapt to them over time and they would fade or my brain would forget them.

It was the daytime ghosting of distance vision that disturbed me the most this past month. Seeing so many objects with a second fainter version slightly offset reminded my of watching the cricket in the 70's and 80's when our analog TV set was getting reflected VHF signals and showing a ghosted image of the players against the green grass. So this past month I have been relying on my cataract eye for distance focus, even though it is hazy and off colour.

The positives were that colour in my new eye was vivid and contrast was strong (I didn't realise how much I had lost) and my reading vision at 30-40cm was now excellent through the new eye and I haven't worn glasses since the day of the operation. Intermediate vision at 50-60cm (computer screen/music on the piano/car dashboard) wasn't quite as good but was usable and I had been told it would/could improve over time.

I was meant to have the second eye done 2 weeks after the first but on the basis of my distance vision ghosting I expressed my concerns to my Optha about doing the second eye (I was worried I wouldn't be able to drive at all). He had never had to explant an Mplus and has had high satisfaction with them, but he asked a lot of questions and listened to me and we decided together to wait a couple more weeks. I think my description of the symptoms was probably greater than any of his other patients had experienced in the first weeks. He did however say that it is hard to judge the final result from only having one eye done, plus I have PCO which also affects my sight at this stage and can be treated later.

We spoke a couple of times during that period (he invited me to call if I had any concerns or questions) and last week after he had spent sometime awake the previous night thinking through my situation (!) he rang me and suggested a plan of using a 1.5D Mplus (ie, the Lentis Comfort) in my dominant eye and doing it fairly soon. The reason for sooner was so that if I adapted better to the RH 1.5D but the LH 3.0D remained a problem the 3.0D could be exchanged for another 1.5D without too much time passing before the explant. He did however express the belief that once I got both eyes done the adaptation would have a better chance then just one eye and a cataract. He was very keen to make it work rather than explanting and I can understand that.

So long story short – yesterday I had a Lentis Comfort 1.5D put in my dominant eye.

I have had the patch off now for 11 hours and I must say that my initial impressions are very good. My eyes seems to be working a lot better together already now that they both have IOL's and even at this very early stage distance vision is a lot more focused ("normal") and ghosting is less noticeable.

As an added bonus, the 1.5D has given me much improved intermediate focus, and I'm typing this at 65cm distance to the screen with no problem (and no glasses).

So in fact with this lens combination I have both binocular distance vision, and near/intermediate mini-monovision. (I can actually read at a pinch at 35-40cm with the +1.5D, but the +3.0D is much sharper at that distance, and with both eyes open for reading the combined vision remains good).

So for me - this is a very positive first day after some weeks of mixed emotions and concerns. Of course this doesn't predict how it would go for you, but it does seem to be a plausible recommendation from your Doctor. You will have to decide however whether your next step is to do the second eye with an IOL like I did, or to change the first eye now (or to go mono focal). I will say that the feel of two IOLs is much more balanced to my sight than one IOL with a cataract eye. They feel like they are working together now for distance focus – even for near and intermediate in fact.

I'm wondering if two MPlus 3.0's may have in fact worked out for me. But no matter now.

I'll report back in a few days on how the +1.5D is going with ghosting and stuff. Seems to be less but it is way too early to make any meaningful comparisons as the surgery is only a day old so there is still swelling and a little soreness.

At this stage I am quietly confident that I will be sticking with these two Lentis multifocal IOLs (one 3.0D and one 1.5D), and not using glasses at all.
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Thanks again for the reply, I'm glad to hear you are having good results with the Comfort lens.  I doubt that my eye will be explanted straight away, so I'd be very interested to see how you get on over the next few weeks.  My eyes were actually OK before this, i.e. I did not have cataracts and was reasonably happy with contact lenses, but I couldn't wear them all the time and I couldn't get on with multi focal glasses, and so I decided to splash out and try for spectacle independence.  In hindsight of course I wish I'd left my eyes alone, but now I'm committed I just need the best solution.  Again, I appreciate your feedback.
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Ah sorry, I wrongly assumed you had cataracts. Yes, those coming from clear lenses and wanting to get rid of glasses are probably going to have higher expectations as you previously had clear vision to compare it with.

I had lead a life with great vision and no glasses at all but then the cataracts started affecting me last year and my vision had gotten very hazy and off colour (no contrast) and I needed +1 glasses to help me read. So from that point of comparison this is a revelation. I can recognise faces outside on the soccer field again and things like that.

One day on and things are very good this morning. It is a sunny day here in Sydney and the view outside is crisp and clear. The Comfort lens has little or no ghosting compared to the MPlus, but with both eyes open the dominant eye takes over so close to being the same as looking through the Comfort lens only. I am much happier than a week ago. Will go out at night in a day or two and see how that goes with the car headlights.
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Three days on and I'm very impressed with this combination. Both lenses working well together for excellent distance focus with no discernible ghosting in most cases.

Colour and contrast are amazing. Everything is so fresh and vivid. Reading well at all distances.

There seems to be less neural adaption required with the Comfort versus the MPlus. It's more like an accommodating lens. I think it will turn out to be very popular for those who aren't good candidates for a full multifocal.
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Hi Hankhill,

Almost two weeks since the second eye (Lentis Comfort) and I'm very happy with both it, and the combination with the Lentis MPlus. Together they are working very well for distance and give a range sharp of near/intermediate vision. Enjoying my sight again.

So nice to see clearly again. I had to drive in the rain the last two nights and that was probably the biggest potential test. The eyes passed the test and I am now confident that I can drive in all conditions. There are still some reflections/ghosting under bright headlights and traffic lights at night, but they are localized to the source and get smaller as it approaches, unlike my cataract starbursts which spread across onto my side of the road.

I'm glad this has worked out so well as I was a little concerned when I just had an Mplus in one eye (like you are).

So if you are going to switch to Comforts, maybe you could talk to you Opthamologist abut doing the second eye first, you might get lucky and not have to pull the other one out.

I hope whatever you end up doing works out and gives you rewarding eyesight, like I now have again.

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How is it going now?  I have had mplus in left (recessive) eye for 4 weeks, and had considered, with my optom's advice, having comfort lens in right eye at some point in the future.  I have cataracts, that was my main reason for the op, having been happy wearing contact lenses for myopia for 25 years.
Optical Express seem to prefer to use mplus, but I will continue to pursue the comfort lens option if I believe it to be a better option for me.
I still have the ghosting and halos just as you have described, and vision does blur slightly at lower light levels, so I am interested to follow your progress
best wishes
Sunnygirl
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How is it going now?  I have had mplus in left (recessive) eye for 4 weeks, and had considered, with my optom's advice, having comfort lens in right eye at some point in the future.  I have cataracts, that was my main reason for the op, having been happy wearing contact lenses for myopia for 25 years.
Optical Express seem to prefer to use mplus, but I will continue to pursue the comfort lens option if I believe it to be a better option for me.
I still have the ghosting and halos just as you have described, and vision does blur slightly at lower light levels, so I am interested to follow your progress
best wishes
Sunnygirl
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Hi Sunnygirl,

I am very happy with my MPlus/Comfort combination 4 months down the track.

Daytime vision is superb at all distances (6/6 vision - [metric]). Colour saturation and contrast is wonderful. Lentis Comfort probably slightly sharper at distance but with both eyes open even better - they work together well as a pair. I think my brain is working much better with two IOLs in then when it had to manage a bi-focal IOL in one eye and a human variable focus lens in the other. Even the MPlus eye seems better with the other lens in.

Comfort lens is useful for computer use/reading music (50cm) when text starts to get beyond the close range of the Lentis MPlus. MPlus comes into its own for reading at 30cm (books, Kindle, iPad, food labels).

Night time vision pretty good too. No problems walking around a darkened house - feels like normal vision for night.

Driving at night - lights and high contrast things like speed signs still have some ghosting around the bottom of them if I focus on them, but unless I am thinking about it my brian doesn't really notice it anymore. Its not like the large circular halos that get reported by people with the concentric circle multifocals lenses like Restor/ReZoom - I think they would be more distracting as they go right around the image

So all good here with lovely clear vision after a few years of rapidly deteriorating cataracts. And no glasses at all is a bonus too.

My Optha is happy with the results and said he has been recommending more of this Lens combination since I had mine done.

All the best with your second eye. let us know how it goes.

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Hi Rockroad
that sounds fantastic, thanks for the feedback.  I am considering having my right eye done somewhere between 3 and 9 months from now - I need to save up again!
One observation I have that differs from yours is that colours in my left (implanted) eye do not seem brighter, but rather they seem 'colder' and not quite so bright.
I think that what you say about your brain working better with 2 IOLs is very valid. I am still operating on a mono vision basis, which does work, but not as well as both eyes working together.
whatever, it is great to not have the cataract fuzziness any more - my right eye is not as cloudy yet as the left one was, and I don't need reading glasses any more, just a contact lens in my right eye.
Interestingly my left eye is now noticeably whiter than my right eye (I never have very white eyes like some lucky people), I wonder if that will remain the case; I wonder why it is.
Hankhill, if you are watching this, how are you doing?  Have you made any decisions yet?
Best wishes, and thanks for all the info - I do like to do a lot of research!
Sunnygirl
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I have also suffered the same outcome with the M+. Initially the surgeon stated that the lens was slightly high. A second op repositioned the lens but the surgeon rotated the lens against my nose without permission ( we had discussed setting it as per manufacturers instructions ).

I find that blanking off the secondary part of the lens with my finger gets rid of the ghosting.

I haven't any solution yet.

I may try eye drops to stop pupil dilation.

Have you had any further results?
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Avatar_m_tn

> I find that blanking off the secondary part of the lens with
>  my finger gets rid of the ghosting.

That's interesting - i think you are right. If I bring a piece of cardboard up from below my eye while looking at a light - just before it block the view the light loses the little ghosted "skirt" below it. It must be covered the near-field lens at the bottom of the IOL.

Not very practical in most situations but I'll remember it next time I am wanting to look at the moon and see it without any ghosting.
  
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oh yes, that works.  How freaky. As you say, not very practical!  I find tilting my head down helps too, I must be using the right part of the lens, but it looks daft
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Hi
just had 6 week check, and optom suggested putting interior light on in car when driving at night so help minimise the halos.  Might be worth a try.
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i had same experience. mplus lens was implanted on me about 6mos ago. ryt after surgery ive experienced ghosting, double vision, halos and glares and im still experiencing it until now which is really frustrating. i had second opinion and the dr told me that explantation is not possible since its been 6 mos already and it would be very risky. im only 31 yrs old now and i cant imagine that ill be living the rest of my life with this kind of vision... is there another way or other option?
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Get another opinion.  I had the mplus explanted after 6 months, and in fact OE didn't want to do it before 6 months, so you are certainly getting conflicting opinions.  The chap in before me had his in for 2 years.  His came out no problem, but mine took an uncomfortable 35 minutes and the surgeon had to leave some of the lens behind.  He got a monofocal inserted and things are way better, no ghosting at all now.  I do still get glare/flare in a room with bright lights in the ceiling.  Oh, and I cant read a damn thing with my right eye now, as its a monofocal lens...
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Hi Hankhill
so would you say things are better with the monofocal than before, bearing in mind that you now have no reading vision?
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I'm so relieved to find this thread. I had OE LENTIS® Mplus  surgery in the summer. My left eye was done first and the ghosting and glare was really bad. The surgeon said it would all settle down after doing the right eye, which he went ahead and did 8 days later. My right eye is the same and neither have settled down. Daytime vision is distracting to say the least, middle vision is really bad, and driving at night is dangerous because of the glare and loss of contrast. I'm also having awful problems with my left eye during the night - it wakes me frequently due (OE say) to dryness. All in all I'm really upset about the whole thing. OE have finally taken my concerns seriously and have offered to explant with a monofocal, explaining that it needs to be done very soon as this is a complex operation which becomes more risky with time - it should be done within 4 months but it's already almost 6 months since I had the op. Until reading this thread I had been believing what I was told - i.e. that in effect it was my fault because I hadn't adapted to them. I'm waiting to see an NHS consultant (29th January 2014) and don't want to make any decision til then but that means waiting even longer. I just don't know what to do.
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I'm so relieved to find this thread. I had OE LENTIS® Mplus  surgery in the summer. My left eye was done first and the ghosting and glare was really bad. The surgeon said it would all settle down after doing the right eye, which he went ahead and did 8 days later. My right eye is the same and neither have settled down. Daytime vision is distracting to say the least, middle vision is really bad, and driving at night is dangerous because of the glare and loss of contrast. I'm also having awful problems with my left eye during the night - it wakes me frequently due (OE say) to dryness. All in all I'm really upset about the whole thing. OE have finally taken my concerns seriously and have offered to explant with a monofocal, explaining that it needs to be done very soon as this is a complex operation which becomes more risky with time - it should be done within 4 months but it's already almost 6 months since I had the op. Until reading this thread I had been believing what I was told - i.e. that in effect it was my fault because I hadn't adapted to them. I'm waiting to see an NHS consultant (29th January 2014) and don't want to make any decision til then but that means waiting even longer. I just don't know what to do.
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Did it help? That's actually illegal in the UK though.
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no it didn't help, in fact all it did was flatten the battery when I left the car in the airport car park!
Although I haven't had the same problems as you have, I am now using a contact lens with no prescription in my left eye, as it kept getting subconjuctive haematoma (I think that's it - burst blood vessels to me).  this is from my own Optom, who I trust after 25 years, OE would just keep giving me eye drops.  My tears are not covering the eye properly, because of a pimple, which was protected when I wore contact lenses for the last 25 years, so can't really blame the op for that - it just brought it to the fore.
I haven't adapted much to the halos etc as described in earlier in this thread, and maybe I won't, but driving, and vision in general is so much better than it was with the cataract that I am happy.  When the time comes I will have the other eye done (maybe by OE or maybe not), and may choose the Comfort lens if my Optom recommends it.
Hope you get it all sorted out..Let us know how the consultation goes.
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Hello Everyone
I am quite amazed by the wealth of knowledge I have gained by reading this thread. I am a surgeon and want to consider using Comfort for instead of the older models of Multifocal IOLs. Out of interest you guys keep referring to your Optometrist. How is that? why dont you have contact with your surgeon? Is this something that is being promoted in optometry shops of the high streets?
Happy new year to all
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Hi
To answer your question, yes, since I had my right eye done 10 weeks ago, I have only seen high street optom, I am also experiencing quite a few 'problems' and we are slow walking the process to see if it settles before making the next decision. I am now so concerned that my optom has contacted the surgeon on my behalf to ask his opinion and I await the outcome.
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Hi Docproushan - I was finally referred back to the surgeon who performed the op in the summer but I have to say he wasn't very helpful and seemed more concerned with defending his position - perhaps afraid of litigation? It's interesting that another surgeon had told me he wouldn't have done the second eye until the first eye had settled down, but I guess that's just down to the surgeon preference - I'm sure they all do what they think is right at the time so I'm not blaming anyone, I just want to get my vision sorted out. The NHS referral has come to nothing as yet - I waited in clinic for 2 hours only to be told by a junior doctor that she didn't have the experience or the knowledge to advise me. She did though assure me that the lenses were positioned correctly (at least as far as she could see) and has made an appointment for me to see the main consultant in February. Of course this delay makes explanting ever more risky and I'm now at the point where I'm too afraid to risk my eyesight again. I'm just hoping that things will improve but, from what I've been told, that's now unlikely :(
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Hi DOCPROUSHAN
my own Optom is a friend, and has been a lot more useful than OE, as you infer the only time you get to speak to the surgeon is just before the op, which is a bit late!  The next day you do not see the surgeon - at least I didn't, maybe you do if there is an immediate problem,.
Anyway, as I have said earlier in the thread, I had to have an op of some sort due to rapidly worsening cataracts, and on the NHS I would not have had the option of a multifocal lens, so I have no regrets, BUT I may consider having the second eye done elsewhere when and if the time comes.  Problem is that 'elsewhere' is best part of twice the price; a sizeable consideration when money is tight to start with!
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DocProushan,

After being initially seeing an Optometrist, he referred me to an Opthamologist and that is who I saw from then on - before, during and after the process.

I have noticed on here that many of the Opthamology practices in the UK seem to be more of an "assembly line" where you hardly meet the surgeon. However this may be due to the operation being under the medicare system of the county, I don't know. Maybe if you pay the big bucks you can have a more individualised experience in the UK.

My experience here in Australia was completely the opposite - while my surgeon did have a number of us lined up to do on the actual day of the operations, I saw him multiple times in the lead up, and then one day, 1 week, and 4 weeks post op (for each eye). There was very good communication - when I was initially concerned about the performance of the Lentis MPlus in my left eye he even phoned me one morning as he had been pondering the situation overnight in bed (!) and had a proposal (Lentis Comfort in the other eye). He asked me to think it over and ring him back directly on his mobile! And gladly it has all worked out very well and both lenses are combing together very nicely.
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Hi Rockroad
I think now I'm in this system it definitely feels a little like an assembly line, but Multifocal lenses are not covered by the NHS here, you have to pay big bucks for the privilege of having this type of treatment so I guess you would expect more one on one with the surgeon before and after. My experience is that I visited the high street provider who did all the preliminary tests and gave me the only option of a lens replacement as Laser would not give me back my near sight which in hind sight was not that bad really, distance was more than perfect and my left eye is practically Plano. I was then referred for treatment at a private hospital where I saw my surgeon for a five minute chat before  the first procedure where he explained my prescription was such that if I got on ok with just the right eye being done he thought there would be no need to do the left, all follow ups have been back at the high street clinic. Since having the right eye lens replacement, Lentis M Plus 3d, I have suffered with ghosting, glare, star bursts and worst of all blurred vision. It's settled somewhat since the op but 10 weeks in the worst bit is the blurred vision/ghosting which is worse in lower lighting conditions but nevertheless there all the time. It just feels like I have something in the right eye which disappears if I close my left eye and concentrate to focus but I can't maintain it as it aches. Anyway after several visits back to the optom she thinks the neural adaptation process is still taking place and the problem is that 2 images are being transmitted to the back of the eye simultaneously which is causing the aberrations and thinks this will settle given time. I'm optimistically cautious as you can imagine and I don't think at this stage doing the left eye will cure the problem. Apart from which if the left eye turns out like the right, I'd be housebound with totally blurred vision! The optom has now contacted the surgeon to express my concerns and I'm currently awaiting a response.......I understand that approx 1% of people never adapt to this lens and I'm hoping I'm not that unlucky. I currently feel that I have sacrificed a lot to gain a little and if there's no more improvement within the next month or so will almost probably wish that is never had this done! I'm in much the same position as Hankhill23 who started this thread. Now I'm wondering if explanting the lens is the only option but who pays for this I wonder.......??
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Hi Soozie64
I had my MPlus done by OE and, although as someone here has already pointed out, I only saw the surgeon 5 mins before he did the op and he was talking so fast he left my head in a spin, before running off (literally) to do the next op. Post-op was with Optometrists in town shops who, I have to say, are worse than useless if you're having problems.They eventually referred me back to a surgeon because I rang their HO and told them my doctor had referred me to the NHS Eye Clinic. I know people who've had lens replacements on the NHS (not multifocal - NHS don't do them because they are so problematic!) and they had a 1-on-1 with their surgeon right the way through - sadly in a private clinic it's all down to cost and surgeons are probably reluctant to spend time in consultation. However, I have to say that OE have told me they will do everything possible to sort my vision out at no extra cost to me - including an ex-plant. Trouble is, the surgeon frightened me so much about the risks involved in that, that I'm now wondering if he did that in the hope I wouldn't have it done because maybe he would have financial responsibility for it! My advice to anyone reading this thread, who is contemplating multifocal lenses through private surgery, is to have the less dominant eye done first and see how it goes before having the other eye done. By the way, I'd like to know where the stat of 1% of people have problem,s with these lenses has come from - I wouldn't be at all surprised if it's far greater than that - and also that it may be dependent on many other variables, e.g. age, contact lens wearers, previous prescription etc... I don't think enough research has been done and I suspect very strongly that we are all part of an ongoing post-clinical trail. At OE after each post-op appointment I was asked to complete an (anonymous) on-line survey about how the lenses were settling down. That worries me.
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I really hope your vision improves to meet your expectations of this exciting journey.

Not all private practises are horrendously expensive.

I am having my first lens replaced on Thursday 16th Jan, at Circle (private hospital) near Bath. OE wanted £1900 per eye for the Mplus. Jonathan Luck, consultant ophthalmologist at Bath eye hospital and Bristol Royal United Eye hospital, charges £2400 per eye to implant the Finevision tri-focal lens, but more importantly, he performed all the pre-op diagnostics, and personally does the pre-op, lens replacement, one day, one week and one month post op checks, and is on the end of the phone should you need help for the next twelve months. I feel this warrants the extra charged over the OE price.

Will report in another thread my experience with this lens and the progress, good or bad.

Phil
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I can't remember my total cost (before rebate) but I think it was over AUD$5000 including opthamologist, anaesthetist, day surgery and lenses. However I got some back on Medicare (your NHS) and most of the rest back on my private health insurance.

When you say "High Street" - do you actually mean a street called High Street, or is that an English term for "the top end of town" expensive medical?
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Good luck for Thursday, I hope your outcome is as successful as mine!  My vision (with Zeiss trifocals) is going from strength to strength, absolutely no need for specs.  These lenses really do seem to tick all the boxes.

Rockroad - High Street is actually a slightly derogative term, used to identify a fast-throughput, conveyor-belt type of business with lack of individual attention.
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I wish I'd known about trifocal lenses, I did research on Google but could only find info on the MPlus multifocal being the latest lens technology. I'd have willingly paid more had I known there were better lens available. I did take my surgeon to task about the MPlus multifocal - I asked him why they're called multifocal when actually they're Bifocal. He didn't have an answer apart from that's what the manufacturer has called them! When I agreed to have them implanted, I had understandably assumed they were what they said 'on the tin'. I've got another appointment with a different surgeon next week, I'll mention the Finevision Trifocal and see what he says though the thought of having my eyes messed about with again is real scary - especially as I'm still having really bad dry eye problems with my left eye.
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Well as you know Jo, i'm booked in to have my Dom eye m+ out on Thurs 16th Jan. I'm still waiting to hear from OE as to what they are planning to put in lol, it's going to bean interesting conversation that's for sure.
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Thanks, so glad you are still improving. Off to bed now, 8:00am appointment tomorrow. Will post a new thread starting tomorrow. I do realise that generally people with problems post on help forums, but I believe it is also important to get a diary of a replacement procedure.

Jo, there are several alternatives but months of research has led me to only two lenses, if suitable, as being AT Lisa tri and Finevision tri. I have looked really hard and just can't find negative reports of either, and they really need not be horrendously more expensive. I don't think though one should be pricing eyes like a tin of baked beans, they are far too precious.

Phil
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Hi Jo000
Your experience pretty much mirrors my own. I've now been referred back to Surgeon for a review. The Optom said she strongly recommends I now go ahead and have the 2nd eye implanted as she feels it would make me feel more balanced. The problem I have is that I'm now very reluctant to go ahead with another costly surgery without some cast iron reassurances that this will cure the problems I'm experiencing, I'm practically Plano in the left eye which was my dominant eye but apparently my right implanted eye has now become the dominant eye....... I just don't know what to think. I don't want to end up with blurring and ghosting in both eyes and to be honest I don't particularly like the way I 'see' with the implanted eye, it's different, colder somewhat. Did the surgeon say what the risks and drawbacks were of ex-planting? I'm keep to share thoughts etc as this might be my choice even if it means going back to glasses for near sight as my distance was always perfect.
Kind regards Soos
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I really can't say what's the best thing to do. I'm nearly 7 months post-op now and the glare and blurring are not improving. However, I have seen two separate OE surgeons and they both recommend I have the (originally) dominant eye ex-planted and a monofocal put in. They say it's risky and I'll have to have it done at Harley Street clinic (at their expense). One said it needed to be done ASAP, the other said it is possible to ex-plant up to 18months but the longer you leave it, the more the risk. I'm seeing a NHS consultant next Tues but I don't expect him/her to tell me any different. So . . . .basically it's my call. My main concern is the risk (worse case scenario is I could lose sight in that eye) but also the fact that they tell me the ghosting will probably go but the glare probably won't (I think it's mainly the glare that makes night driving difficult) + I'll need reading glasses. Weighing all this up I've (almost) made my decision - to leave things as they are. I hope that as I get more used to the weird vision that the problem will diminish and my brain will eventually accept it!! But it's a tough call!
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Hi Jo000
From what you say it's a heck of a dilemma you're facing, damned if you do n damned if you don't.....I just don't think I can put up with the blurring/ghosting forever, it kinda defeats the object of having this done in the first place. I'm 14 weeks in, seeing surgeon in another 6 and am not hopeful that anything will change in that time. I certainly do not want to sacrifice the perfect sight I have in my left eye in the hope it will be the 'fix' for the right eye. Keep me posted if you will, it's good to know we're not alone and like you I suspect the 'real' stats would show a higher percentage of people having similar problems. I'm also not doing anymore online surveys in the store.
Regards Soos
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Did you have the ex-plant? How did it go and how's your vision now?
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Hi Soos - I'm wondering if it's worse for you because you were long-sighted to begin with and so could see distances clearly. To now have impaired distance vision must be terrible. I was short-sighted and so always wore glasses or contact lenses for distance so at least I can now see distances without glasses even though there is ghosting there. If I transplant one eye with a monofocal I'll need reading glasses, which I've never needed before. I think it's that more than anything that's making me think I'll leave my eyes alone now. Yes I have ghosting and glare BUT I don't need to wear any glasses and the only reason I had this done was so I could dispense with glasses and contacts. I think I'll get used to it in time - and honestly, I just don't want to risk my eyesight by swapping one set of problems for another. And also, re: the OE surveys - they don't ask me to complete them anymore either, and also whenever they send me correspondence it seems to infer that I had laser treatment, not lens exchange!  Jo
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Hi Jo000
It will be interesting to see what the NHS consultant thinks following your appt Tuesday, they should at least be impartial? Hope your eyes settle and you don't have to make any decisions whether to risk explanting etc. I'll let you know what OE say following my surgeon review, just wish I could go to the new clinic 1/2 hour away instead of having to go back to the one over 2 hours away to see the surgeon that performed the first implant, he won't be doing the other eye regardless.
Cheers Soos
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Umm. . .well . . OE made me go back to see the surgeon who'd done the op (a 2 hour drive away) because the local centre wasn't open when I had my op. So I did a round trip of 4h having been told there were a number of options to discuss, only to be told ex-plant was the only option. They didn't do any tests - I could have been told that on the phone! Today, I've just got back from my NHS appointment - pretty appalling really! They keep cancelling the appointments and not letting me know - and that happened today. Another 2 hours wasted. My last NHS appointment was 23rd Dec and after waiting for 3 hours I finally saw a doctor who said she was a Junior doc and not qualified to deal with lens implants. Hence my appointment today. I now have another appointment on the 10th March but I expect they'll cancel that without telling me as well. Oh and whilst driving back home, a stone hit my car windscreen and cracked it!!!!! The Universe seems to be telling me something!!
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Oh crikey, you do seem to be having a time of it at the moment!! I do hope I don't end up going all that way for a similar response, I will be cross if this happens. Can't seem to find any information re contra-indications/risk of explanting, going to do some more digging, forewarned is forearmed as they say.
Regards Soos
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I feel for you both with your ongoing battles to get some satisfaction from OE. I know the excitement that exists at the start of this expensive journey. For it to be compromised in this way must be so frustrating and worrying. Whilst my vision isn't yet perfect, it is at least without complications. I wish you both well in your quest to have the vision you both deserve and have paid such a price for. Do please keep us all informed as to the progress.

Phil
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Hi, I'm a 52 year old male, I had cataracts and M Plus IOL's implanted in January of last year (2013). It's OE, the op was at Westfield, I can recommend Byron Burger. This January I had laser correction on the left eye to no particular avail. I'm still suffering from low contrast and blurred vision. That being said when I read a chart I'm seeing 6/6 or better, and my reading vision is great. Sounds like the ideal outcome? Well, not really. Intermediate distances are little short of atrocious, at 3 - 5 meters I find it hard to recognise faces. Quality of vision between left and right eyes varies markedly. High contrast edges produce ghosting / fringing, point sources –especially at night – produce semi-haloes underneath. I beat up BUPA last year to pay for a second opinion from another surgeon and he was of the opinion that the operation was fine, the health of the eye is good, the implantation was correctly centred and that my vision should be good. Therefore it seems inevitable that this is a neuroadaptation problem. This was effectively confirmed by an OE optician just this week who recommended me make an appointment to see Prof Jan Venter, potentially with a view to explantation. Gulp.
I am unclear as to: the specific dioptre of the M Plus lens, whether the original operation involved a posterior capsule YAG capsulotomy – I’m inclined to assume not if OE are even contemplating explantation – and what my options – surgical and non-surgical - are. I’ve seen Jan Venter before, he seemed like a reasonable guy and gave my eyes a very thorough examination. That being said this is the only direct contact I’ve had with him and whether that’s sufficient grounds for letting him scoop my eyes open with a sharp implement does give me pause.
I feel as though I’m looking at the world through a ground-glass screen. It’s subtly disturbing and presents unexpected problems. When looking at a computer screen for example I find myself searching for buttons or icons that previously I would have found immediately. The speed with which I recognise things has reduced. Driving is not too bad, but lots of haloes and I really have to concentrate at night (not saying that I didn’t previously, but I’m sure you know what I mean!)
I’d be very interested in comments about alternative lenses, how people felt about the explantation experience with OE, just how dam’ scary that op is and so on. I spend about 9 hours a day in front of  a computer (CGI and graphic / 3d design) so I may be overly sensitive / downright paranoid. I know I need to do something, I’m just not sure what...
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The condition of my sight is exactly as you describe, in every detail. I've decided to leave it be and hope that I get used to this new way of seeing the world. It seems apparent to me that explantation will just swap one set of problems for another and the risk involved in removing the M Plus seems too great - though one of the OE surgeons did say he explanted one guy after 18 months. I still haven't got to see the NHS consultant yet - they've messed my appointments up so much that they've now promised I'll get to see the senior consultant on 10th March. I'll report back after that but I don't think he'll tell me anything I don't already know.
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Thanks for the info Jo000. I've Just in the past 15 minutes had a call from another surgeon who has a cancellation available today, so basically I'm going for a second opinion before I see OE. I think this is going to cost me a chunk of money, but as you say the risks of explantation seem so high that to even contemplate it without getting as much information as possible seems insane.I think the seething resentment here is that I did explain to OE at the outset what I did for work and what my expectations were, and these were glibly overlooked. I was told in my initial consultation that they could guarantee 6/6 vision over distance but would not make any promises about close-up / reading, which seemed fair. However, at my most recent consultation the OE optician, who seemed competent, truthful and concerned, told me that the quality of vision from M Plus lenses even at a distance would never approach that which I had with rigid gas permeable lenses. Now, I'm biased because of my job but for heavens sake, this is the 21st century and Photoshop has been around for over 20 years. Is it much of a conceptual leap to take some pictures on a camera and then illustrate the types of phenomena and quality of vision that results as an outcome? Given that these techniques exist and have existed for many years, how is it possible for OE and others to claim that they are providing sufficient information for informed consent when they purely rely on text descriptions? It's the subtle misdirections that annoy me most, covered by the blanket excuse that they don't want to suggest problems to the patient before the patient has noticed them themselves. It's rubbish, its disingenuous - and damn, I'm starting to rant - sorry! Better stop now before I turn green...
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I agree totally about the visual information. When the concerns about my vision were continually dismissed by OE at the follow up appointments - they kept saying, "It'll clear. It'll adjust. It just takes time," - I actually photoshopped some photographs to show them what I was seeing. The surgeon who did the op in Manchester wouldn't even look at them, he said he knew what I was seeing and didn't need to look at photos. Re: middle vision - I'm an author and work on my computer nearly everyday - and yes I told them this BEFORE the op. My computer vision is appalling and seems to be going worse. In fairness OE have ordered me glasses to wear whilst on computer but I'm still waiting for them after 5 weeks. So yes, rant away - I'll join you!
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Well, I had an interesting visit to another surgeon in the area on Thursday. He examined the eye and said that then lens was well centred and that it had  been implanted correctly. He was in fact pretty complimentary about the job the OE surgeon had done. He also said he'd heard generally good things about the Lentis lens although he said he used a different brand purely because he'd had good results and had no reason to change. So anyway, it confirms mine is a neuroadaptation issue, which I'd pretty much suspected, but it was good to get it confirmed independently. So the badd news was that explantation is risky, and implanting monofocal lenses in these circumstances is no guarantee of good vision. Basically I was told to man-up and get used to it. I won't go into my reaction to that because it would be pointless, but suffice it to say the unappealing prospect of explantation just got even less appealing. An upside, maybe. First he thought the laser surgery I had on the left eye would reset the clock as far as adaptation was concerned, so I should  view my situation as being only a month or so into the process, not a year. Second - well, I'm not sure but I do feel I see some improvement in the inferior eye when I wear an eye patch over he dominant one. I'm going to see if forcing adaptation helps (I tried the gabor patch software, its not very good software so the results were inconclusive) but I do wonder if this is a process which can be jumpstarted in any way. Not wishing to sound fatalistic, but 'we'll see...'
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You've been told what I expect to be told - and actually what I've already accepted, as I do believe OE when they tell me it's a neuro-adaptation problem. In my case not helped I think in that I seem to have had a dominant eye reversal since the surgery. Interesting though that you mention aids to adaptation and also the possibility of laser fine tuning - I'll investigate both those options. I'll wait now and see what the NHS consultant says on the 10th March but I don't expect I'll be going down the explant route either.
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'He said he knew what I was seeing and didn't need to look at photos.' I've been chewing on that since you posted it, and a few things came to mind. How did he know? Has he had MF-IOL's implanted himself? Undoubtedly he's heard descriptions of patients outcomes but to me such images would be a very important and interesting data-point, a useful reference even if only from an academic perspective. To ignore them seems to suggest a worrying degree of complacency.
Second thing comes as a result of a conference I attended in 2000. ACM SIGGRAPH is the leading event for computer graphics, and one of the hot topics back then was something referred to as simulator sickness. It was interesting then because of the expectations of virtual reality headsets, and is in fact coming back into fashion now because of the Kickstarter funded Occulus Rift project - a gaming VR headset. Anyway, I sat through a rather lengthy but fascinating panel on simulator sickness and its commonalities with motion sickness, sea sickness and even space sickness experienced by astronauts in microgravity. The underlying topic was in fact neuroadaptation and how the structures - whorls - on the back of the brain physically change shape as a consequence. The defining paper in this area seems to be: Sensory Rearrangement Theory, presented by Reason and Brand (1975). You can read an update on this at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1436193/pdf/jrsocmed00291-0059.pdf (Reason is basically arguing that this gets better over time) and see how influential the thinking was by glancing at: http://www.hitl.washington.edu/publications/r-98-22/ch9.html or many other papers which are freely available. Sorry, this is long-winded but you mentioned you're an author so I guessed you might have a liking for research :)
My point really is this: neuroadaptation is an extremely large field, some of the best research has been funded by US DARPA programmes (the interest is mainly flight simulators) and every surgeon I've come across so far is just playing at it.
They don't have a damn clue. Their main area of interest - rightly so - is in the mechanics and optics of the eye; to claim that they're now also experts in the the extraordinarily complex changes which occur within what is actually the most complex known structure in the entire universe - the human brain - is disingenuous to the point of being risible. If your surgeon was even vaguely interested in neuroadaptation he'd have bitten your arm off to take a look at those photos. 'He knew what I was seeing.' Prat.
The whole multi-focal lens industry is based on a subtle lie, which is that manufacturers and surgeons sufficiently understand what's going on with the second part of the vision system - the brain. Multifocal lenses are inherently unnatural, and for them to work something equally unnatural has to happen - inside your head. I just wish they'd stop shrugging their shoulders and saying 'yeah, that's neuroadaptation for you' and actually have conversations with neurologists and neuro-thereapists who might be capable of devising strategies for fixing the bloody problem.
Yep, that'll be a rant then...!
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My surgery was to rid me of glasses.

Pre implantation of my M+. I was wanting to get my non dominant eye done first. The week before surgery I was advised by the consultant to have the dominant eye done. It was done, but I had major issues of ghosting and blurring of images from 5' to infinity. The worst was not being able to recognise faces of people about 20' away.  My initial op was Nov 2012. Symptoms as described - basically the two images were overlaid and caused blurring. A second image is not noticeable, its just like looking through a slightly opaque lens. Close vision was OK, but everything beyond 5' was poor. After three months the surgeon suggested that the lens was slightly too low in the eye and he could adjust its position. He even suggested rotating it 180. I wanted the lens as per the manufacturers instructions. The surgeon reported that the op went well - but whilst still lying on the couch with the patch on, he then said that he had rotated the lens towards my nose.

Its over a year since the "adjustment" and the symptoms remain the same. To try and force neuroadaption.the surgeon has suggested wearing a single lens on the non dominant eye. This has just shown me how much I have lost. My dominant eye used to be about 30% better than the non dominant eye (in terms of quality of vsion) now my non dominant eye (with a corrective glasses lens) is about 30% better than my dominant eye. When wearing the lens, half the time my dominant eye appears to switch.

Surgery is genuinely my last, but probably only, option now. Probably going to have to explant and replace with a mono. This leaves me much worse off than before the initial surgery. I'll be permanently stuck with reading glasses! (if all goes well)

Yes the warnings pre -op were serious. Threats about going blind - but they were so unrealistic ! Nothing about so many people not adapting to the lens. I think that patients should be told the actual percentages of contraindicatons, preop, instead of - being told post op "weve done thousands of these and never had the problems you're describing"

I really wish I hadnt had the initial op!
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Thank you Peppersghost - this is really useful. I'll read the papers before seeing the NHS surgeon next week and maybe request a referral to the neuro clinic.
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Really sorry to hear your report - and concerned too because it looks like all of us on here will be in the same position after 12 months. If someone had shown me a photoshopped photo of how I would (might) be seeing the world post-op, I definitely wouldn't have had it done either. I'm 7 months post-op and my vision is still changing - distance remains the same, middle vision is terrible now, near vision is not as good as initially post-op, it's now about what it was pre-op, ghost and glare still present, and watching TV has become irritating because of the glare, fuzzy faces and huge halos of light around the screen :(
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I'm starting to wonder if a complaint to the advertising standards authority isn't in order - I can't think of any other industry where you'd get away with this. Mcav8r, when you say the surgeon thought the lens was too low in the eye did that have any other side effects? Reason for asking is that I've noticed when looking at relative positions of things from left eye to right (such as your thumb held at arms length) they tend to move diagonally. Before the op I'm pretty sure I only saw horizontal movement, not vertical as well. Not that it's especially helpful, but I'm starting to wonder if my inability to adapt is in part down to the different positions of views of my surroundings - the left image is too far out of place, the brain can't compensate and so blurs it. Just curious if anyone else is seeing this also?
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Hi Peppersghost, I have checked out the relative views from the different eyes. My left still has the natural lens, the right the M+. Very minor differences in position perception, the left eye on its own sees an image which when viewed from the right eye is larger and slightly up and to the right. Its as if when resizing a computer window, the top right corner is dragged diagonally to enlarge it. I dont think however that this is an issue.
To view things clearly at intermediate and far distance I have to shut my right eye. Or tilt my head away from the object so that teh near vision part of the m+ is blocked from seeing the image by my nose! When I do that (block out the near vision part of the lens) I am very impressed with the quality of the image.

If I only had one eye, the one with the m+, my vision would be completely unacceptable.

I really am very disappointed with it.
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Hi Jo
I saw my surgeon yesterday to discuss the problems with blurring/ghosting/haloes etc. firstly I have to say he is a very nice chap indeed, he reassured me there is nothing physically wrong with the lens, my eye looks good and I have 20/20 vision with some improvement in my near sight to what it was but I'm seeing different images being transmitted to the retinas and my brain just has to adapt. I need a YAG laser treatment to clean up the lens as it's clouding, a bit like having cling film over it and this might be a contributory factor to the star bursts I see around light sources however if I have the YAG I won't be able to explant so I have to wait to see if I can adapt before deciding to explant, YAG and have the other eye done.
It's just very frustrating as you know to gain little to nothing and to have effectively compromised so much more!! I'm not having the left eye done in the hopes of correcting the problems with the right eye as this does not make sense to me, I'm in exactly the same position as you, Peppersghost, Mcav8r as we have blurred vision........which we did not expect!
How did your appointment with NHS chap go and how did you get that appointment? Have you gone private or was it GP referral?
Hope to hear from you soon, kind regards Soos
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Hi Soozie - my appointment was on Monday and, yes, it was a GP referral. They dilated my pupils and did a thorough exam. The Consultant confirmed what OE had said - that the lenses had been implanted perfectly and were central. However, he explained that it's well nigh impossible to control the position of the lens in the eye as it all depends on the shape and size of your lens capsule. Each lens has four 'legs' that attach to the inside of the lens capsule and all the surgeon can do is place the lens in a central position - he has no control over the shape/size of your lens capsule, which obviously will be a factor in how the lens sits. That makes a lot of sense and it's this that probably accounts for the ghosting. I asked him about neuroadaptation and he said he'd never heard of it. When I explained he seemed to think it was nonsense. I agree with that too - if you've got two images falling on the retina, you're going to see two images no matter how much you tell yourself you're only seeing one. Of course you can learn to ignore it but that's not neuro-adaptation - that's just ignoring it. He also said that he does not use multifocal lenses either in his NHS work or his private work - because of these potential problems. When I asked him what he'd do if he was me, he said he'd have the right lens explanted and a monofocal put in - he also said this would be safer being done by OE as they are used to working with multifocals whereas NHS consultants are not and the op may take longer and carry more risk. So basically his advice was exactly the same as the OE surgeons. So, what to do? I'm still wary of the risk involved in explanting and having to go through the healing process all over again. OE have just given me glasses to wear for computer work, so at least I'm not struggling with middle distance vision now. The ghosting during daylight is becoming less noticeable I think, but night time driving is still really problematic - and no one can tell me whether that will improve if I have the explant, though the NHS consultant thought it might.It's now nearly 8 months since I had the op and I know I must decide soon what to do - I just seem to be paralysed with indecision and want to just carry on burying my head in the sand in the hope it'll all just go away :(
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Jo000, I've got to be honest, for an ophtalmic surgeon to say he's never heard of  neuroadaptation seems more than a little frightening to me? Disagreeing with the premise is one thing, but never to have heard of it? The surgeon I saw gave the same 'wait and see' line, but he also pointed out that the risk of not achieving a satisfactory outcome with monofocals was also high. I'm not seeing Jan Venter until next month, but I've pretty much decided not to explant - it feels like it could be jumping from the frying pan to the fire...
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Thanks for your comments, let us know how you get on. As for the decision whether or not to explant, I'm feeling like I'm plucking petals off a daisy: I will explant, I will not explant, I will explant, I will not . . . . . . . ad infinitum!
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So glad I found this thread as I went to OE today and was told about replacement lens as I had never heard of it before. I had a consultation 2 1/2yrs ago with OE regarding laser but would have been swapping one pair of glasses for another (Im short sighted). I thought mplus was an alternative to wearing glasses for distance and was quite exited about taking this further with an appointment until I came home and read the comments posted by people who have had the op. It wont be something that I will be following up as the downside sounds terrible and I feel for all of you who are having ongoing problems. I tried varifocals for a few days last year and couldn't get on with them so I don't think my neuro transmitters adjust to drastic vision changes very well so I'm going to give replacement lens surgery a miss but I will look deeper into the finevision trifocal data for reference. Good luck to all of you and I hope your eyesights improve in the near future. Alan
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Hi Alan
If I could go back to last August I think I would still have the implants BUT just my non-dominant eye and wait to see how/if that settles. If it doesn't settle, I'd have a monofocal in the other eye. Here's my situation almost 12 months down the line -
I don't need glasses for anything - though I do have a pair that slightly magnify middle distance writing, though I only use them (infrequently) for looking at music on my iPad when I'm playing guitar. The ghosting is still present though I hardly notice it now. If I focus on it, it can be a bit irritating but the majority of time I don't notice it anymore. Nighttime glare is still a problem but I am now driving at night - though more slowly than I did before! I'm probably now one of those drivers I used to follow whilst shouting, "If they can't see, they shouldn't be on the road!" LOL  All in all, I have accepted my revised vision and it is good not to need glasses. I decided against ex-plants mainly because I realised I would probably just be swapping one set of problems for another different set of problems and it didn't seem worth the risk. As for your decision - it's likely that better, less problematic, lenses will be developed in the future although they can never be as efficient as the natural lens because that's connected to all the peripheral tissue and control mechanisms. As for neuro-adaptation - they lead you to believe that the ghosting/glare will go away - it doesn't, you just learn to ignore it and develop unconscious strategies for coping with it.
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I've now had a slightly different experience. I had the lenses in Jan of last year, had loads of problems (further back along this thread). I had laser 'top-up' with OE in Jan of this year, a month or so after that I was depressed, dejected, contemplating explantation even though I technically don't need glasses for anything. I decided to see another independent consultant, which cost me a couple of hundred quid, and he gave me the really bad news. By this stage switching to monofocal would likely make little improvement. He did give one glimmer of hope though - he said that the lenses had been well fitted, the eyes had healed well - and that by having laser surgery I had effectively reset the clock on neuro-adaptation. Now, I know this is basically rubbish because there is no known underlying scientific basis for neuro-adaptation - that's to say nobody knows if it's a real process, and if it is a real process what the physical process behind it is - are you growing new dendrites, more cells in the eye or is it just the good vision pixies dancing on your eyeballs? I did some more digging and came across a research group who had published papers on simulating the process of neuro-adaptation and got in contact. They basically confirmed that they didn't now what was going on - however, they were equally convinced that - something - did in fact happen and there was in fact a process. It's just unknown, unmeasured and unpredictable. Pixies are in fact as good an explanation as any. All that being said - the weather got better around 15th of March.
And that was one hell of an eye opener for me. It happened over the course of only a day or so, but in particular on the 15th. I remember it because we'd gone to London to see a show in the afternoon and spent the rest of the day wandering around. And my vision was f***ing incredible, at all distances. I'm surprised I didn't get punched in Covent Garden, I spent the rest of the afternoon just staring at people's faces in a fairly rude fashion - but they were actually in focus, no ghosting at all. Buildings were pin sharp. I could read close-up text. Even in reduced lighting conditions things remained sharp, although in the darker areas of a Chinese restaurant things were still a bit soft. Amazing, right?
Well, so-so. It' hasn't stayed that way. I do get back to having sharp vision - but only when I've been away from work for a couple of days. It's very noticeable that when I spend long days working on the computer (on a pair of 21" monitors at about 14" - 18" distance) my vision slowly deteriorates. Clearly I need another job. But it has given me hope that vision can improve, and can do so slowly and over time. I know now that the lens is okay, the eyes have healed and that under certain combinations of circumstances my eyesight can be brilliant (talk about caveat emptor!) So I may be being naive, but I'm now basically optimistic about the quality of my eyesight improving - eventually.
As to recommending the op though - that's an entirely different question...
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Just to add to this thread, I have had an explant 2 weeks ago and when I get time today, I will let you know my thoughts and experiences so far.
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That's fantastic - I'm so pleased for you. And just to support what you've said, I've noticed exactly the same. The odd times that my eye sight seems crystal clear is when I'm out hiking - and I've kept thinking that perhaps I'm imagining it cos it doesn't seem to last more than a few seconds. I'm a writer and I work on my computer almost 24/7 and I find if I jump in my car in broad daylight after working on my computer, the ghosting can still be really bad. Still, reading your post I'm newly optimistic for both of us.
Interested to hear your experience superam
Jo
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Well after tooing and froing on an explant or not, I finally decided to have my R/E (dominant) eye, multifocal taken out, after many consultations with Prof Jan Venter in Westfield, White City. My sight with both multi's was very similar to what other folk on here has experienced, with all the same side effects, manageable but with a feeling that I could achieve better. Anyway, went down, 2nd to last one in, on the table for what seemed like an eternity. Jan Venter said he would have to cut lense in 2, to remove it (which I knew about anyway) but after a lengthy period of prodding and pulling, I asked him if he'd got it into 2 pieces yet and he replied, it's in 5 pieces now but i'm struggling to get it out. For the first time I felt slightly nervous at this point but knew I was in good hands so composed myself and let him crack on. Around this point I started to feel the pressure to my eye being added and it was because the effect of the anesthetic was wearing off. The Anesthetist promptly squirted more into my eye and off we went again. Finally got into the recover room, with a Mono focal in R/E set for distance.
Spoke to Jan not long after and he said it was the hardest one he'd ever had to extract and had to leave the bits that hold the lense in place behind (this I also know could happen) but it no way effects the new lense. I was travelling back home that night to Derby, with my check up booked for Notts in the morning, but Jan tried to get me booked into an Hotel in London that night because he specifically wanted to see me in the morning but as it happened no Hotels were available, so he insisted the Optom in Notts rang him straight after i'd been checked. I must admit that unnerved me abit, thinking there might be problems ahead but had no choice so off home I went. Check up next day went fine and the info was relayed to Prof Venter accordingly.
Now the bit your all most interested in lol, how's my sight now.
Well i'm normally very inpatient but with this i'm afraid going to have to be very patient imo. As of 2 week on, my sight is worse than with the Multi. That said, there are differences,  ie
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Sorry it just posted as I was writing,anyway
diference I've noticed are the glare as subsided somewhat but the shadowing/double vision is still there at the moment, everything else is the same as the Multi, apart from the close vision, which has little worse but I can still read my phone at a push with just that eye only.  I do realise that it's only 2 weeks on and i'm still applying drops very regular so I'm more than happy to let it all settle down before giving my verdict on the explant. I've got another check up in 2 weeks time, when it's should show whether my visions improving with the Mono (fingers crossed.) I will comeback on and post my latest report then as I know there are quite afew people in my position, wanting to know if it's worth the risk.
I've spoken to someone else who has just had 1 multi replaced and he said his situation was very similar to mine at my stage, he has had 2 'laser' cleans up's on it since his explant and he is now extremely happy with the result he has got, that give me hope and hopefully afew others aswell. Nice to finish on a positive note.
Jan Venter and the OE staff were excellent allday long I must add.
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I'm sending you a little prayer and a lot of healing, it sounds like you had/are having a tough time. I'm certain this ex-plant would not have been done if there had been any doubt that your vision would be worse than before. Hope it all resolves - and please do let us know how your recovery progresses x
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Well 2 further weeks on and after my 2nd check up with the Optom . My vision, in my new Mono eye, in my opinion is not very good at all at this moment in time. Optom has suggested, surprise surprise, a YAG laser treatment, to clean up the cloudy area he says I have in my lense and then have different laser treatment to sharpen up the vision in the eye. A large part of me thinks that's just the standard response given to all patients that say they are experiencing problems, sort of 'well lets give this a shot and see how it pans out' and barring in mind, this is the same Optom that convinced me the MPLUS was the all singing and dancing choice for perfect vision, so I think I will take his advice very cautiously. I do realise that if I have the YAG I wont be able to safely explant the R/E mono, but to be honest I don't think I will ever contemplate that anyway (there is not much else left to put in)
I am waiting for some temp glasses from OE, just to level our my vision for distance until my next standard appointment in 4/8 weeks, where I fully expect my vision to be the same as it is now and to be told 'yep it's time for your YAG lol. I think in that time I might get a 2nd independent opinion on things, just to satisfy my own thoughts. My Optom did say that things were progressing nicely lol, well we shall see and i'm not convinced YET. I promise to keep people who are interested in my outcome informed and not just drop off the forum like I've seen quite afew people do. My fingers are firmly crossed.
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Very best of luck Superam. I'm assuming it's distance which is still bad? Yes, YAG seems a scary step. I also distrusted the advice from my optometrist and have had two independent assessments from different surgeons over the past year or so and both said the same thing; surgery went fine, eye is healed, all good. Well, maybe. I have good days and bad days - I have to say, good days are very good indeed - and since the laser (corrective, not YAG) treatment things have got noticeably better overall. But I've become very conscious of the fact it's not only lighting, but also what I'm doing during the day which makes a difference. Sitting staring at computer screen leads to bad days, which is a bit of a drawback as that's my job. The other really weird thing is having different parts of my vision 'ghosting' on objects at the same distance depending on how contrasty the colours are. I mean I guess it makes sense when you think about how the lenses work, but they sure as hell didn't mention that at the outset. I suggest therefore re-naming this forum 'The League of Extraordinary Guinea Pigs', as I'm convinced those buggers who keep sticking sharp knives in our eyes don't really know what they're doing!
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Well it's been over a year now since I had my cataract IOL surgery so here's my update:

Lentis MPlus in the left eye and Lentis Comfort in the right eye in the first half of 2013.

Eyesight is fantastic. Have not needed glasses at all - able to focus for near (MPlus), Intermediate (Comfort) and distance (Both).

Bright days are wonderful and crisp. blue skies are amazing.

Able to drive at night comfortably without problems. There is a bit of ghosting under headlights but only if I am thinking to look for it. Otherwise I don't even notice it these days unless you asked me.

If you read my earlier posts you will see that the MPlus on its own gave me some concerns but after getting the Comfort in the other eye the two have worked together excellently, giving essentially a tri-focus, and good distance vision.

I wish there was a better way to know how multifocals are going to go for you before you go under the knife - so many mixed stories here on med help.

My un-expert opinion is that the Lentis Comfort is probably a little more forgiving in the adaptation, and may be a safer bet to the MPlus if you were concerned. Two Comforts would be quite acceptable for most things including computer use, but may require glasses for close reading.

For me - it has been a very happy, positive experience. Loving my vision.

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Well this is all very disconcerting!

I have monocular vision. My left eye is lazy and only contributes peripheral vision to my vision. My right eye is the only eye I really use. I had the MPlus implanted just over two weeks ago. I am almost 50 and my near eyesight had gone to pot. Doctor promised crystal clear near vision and thought my distance vision would improve too.  Two weeks in the near vision promises were true. My near vision is awesome! Like I was 15 again.

But, sadly, anything beyond 5 feet and especially out beyond 20 feet is like everyone else is describing. Ghosting everywhere! A slight offset at 5 feet, about 6" offset at 30 feet and by 300 feet a couple feet offset. So, for example, looking at people walking on a sidewalk 300 feet away I see two of them - one normal and the other a following ghost. As you come up to 40 feet away they are about 80% overlapped.  If I am in a darker area and there is a lighter area out ahead I see crap. So, looking down the hall at my wife standing by the lit elevators I can't make her out some 60 feet away. Or standing at the back of a Starbucks, looking into the room with bright windows behind the whole place is a blurred mess.

I was hoping this might clear up in next two weeks, as my Doctor says it can take up to 4 weeks for eyes to settle down. But My distance vision has been like this from about day 5 and I don't see any real improvement 15 days post procedure.  I have a follow-up appointment with him next week.

It would be horrible if I had to 'explant' to a monofocal lense. That will leave me $4,800 Canadian out of pocket with WORSE vision than I had going in!!!

...Dale :(
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Don't want everyone thinking I've dropped off the discussion cos everything's hickydory now LOL
I'm 12 months post-op and the ghosting has not improved - but I have got more used to it I suppose and so don't notice it as much. Like Peppersghost I have a few okay days and lots of very bad days. The bad days are when I've been working on my computer all day and then jump in my car to drive - yes, like Peppersghost, computer work is my job and so my eyes are bad most of the time. Currently I'm in the throes of moving house and so have not rung for a 12 month follow-up appointment (I was expecting them to send me an appointment but I guess OE hope we'll forget). I read Rockroad's post and am really pleased it's worked out for you - I don't think I want to chance an explant after all this time though. Anyway, I'll keep checking in from time to time - good luck everyone.
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My surgeon responded to a recent email of mine with the following encouraging response. I will update this thread when I have more information to share :

"Thanks for keeping me in the loop. I need to see you to determine if there is a residual refractive error. A small degree of myopia, hyperopia, or astigmatism can blur vision for distance. If this is the case then laser vision correction can make a significant difference. 98% of my patients that I have inserted the Mplus lens are very happy. I have never had to remove this lens. Lets wait for another assessment."
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Hi, I found this forum because I'm gonna revisit Moorfields, Dubai, next week. I had both eyes done with MPlus in June/July 2012 because of one bad cataract, and a baby one. I did zero research on the lenses, foolishly only listening to the hype and ignoring the "small print".

I have amazingly sharp distance vision (day time only) and no longer need reading reading glasses. However, my night vision is appalling - halos, glare, fog - impossible to drive, and zero neuro-adaption after some 2 years post-op.

Shortly after my ops the surgeon recommended Pilocarpine eye drops........... my problem occurs when the ambient light level drops and my pupils dilate - I lose depth of field, and the exposed lens-edges give me the LSD effects. The eye drops constrict the pupils - so I lose the glare, but unfortunately I also lose a lot of available light due to having a smaller aperture - so outside of town (no street lighting) driving becomes hairy as I can't see the road markings clearly.

I love the glasses-free effect, but I'm wary of having to use Pilocarpine for the rest of my days (they alter the fluid pressure in the eye) PLUS star-gazing is a distant memory - I just can't see stars below around magnitude 1 (1 is quite bright). Night driving is just a misery.........

I'm not sure if Moorfields will be able to help out......I thought I'd write this because Jo000 may not have heard of the Pilocarpine option (her post-op experience seems similar to mine). I also read recently of Alphagan eye drops - I aim to check these out when I visit Moorfields.

BTW.......I read recently in a UK paper about new lenses called Symfony (spelling?)...........they allegedly overcome the psychedelic effects of earlier multifocals.
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OK, today I saw my regular eye doctor. She gave me moisturizing drops to take in addition to the anti-glare (Voltaren) and antibiotic (Toradex) drops that my surgeon gave me to take for two/four weeks respectively post procedure.

I emailed my surgeon in advance to see if he was fine with the lubricating drops. I also specifically sent him a link to this thread so he fully understood my situation. This was his response:

"Yes the lubricating drops can be very helpful.  Internet information can be very misleading. There have been over 200,000 Mplus implants in Europe.  Even if  0.5 % of patients are not satisfied that is 1,000 patients with the remaining 199,000 being happy.  It is rare for happy patients to take the time to comment on the internet.  See you soon.  "

My regular eye doctor also did a full exam today (5 days before I return for my follow-up visit with my surgeon next week). Along with the reassuring emails from my surgeon quoted above, she said that it can take some time for the eyes to settle. She also said that it will take some time for my brain to adjust. But she also said that, as at this moment, my MPlus lens is the 'wrong' prescription by a couple degrees. She showed me by putting lens in front of my eyes. The ghosting disappeared and my distance vision was restored in her office.  But those lenses (you hold them up in front of your eyes like glasses) knocked out my close up vision. She said that my eyes may settle into the right prescription over the next month or two. She also said that if they don't that Lasik surgery would probably fix the remaining problems.

After I left her office, I wasn't sure if she meant that the Lasik could be done in a way to restore my distance but still retain my close up. I assume it can.  I'll definitely ask my surgeon this when I see him next week.  I'll keep you all posted.

BOTTOM LINE: I wanted to post here especially if things get better because I wanted people like me who find this thread a few days or weeks after the procedure to understand that there is still hope that things will get better.  Of course, I'll continue to post about my saga as time passes to describe my interim and final outcomes as they arise.  My fingers are still crossed and after discussing this with my eye doctor and receiving the emails from my surgeon I have renewed hope for a good long term outcome.

...Dale
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Thanks for the tip about the eyedrops Tyrotrainer but my optician did prescribe those for me earlier this year. I had an unbelievably horrible reaction to them - after just one drop in each eye. It took me by complete surprise because I'd no idea they could have such devastating side effects - my doctor called an Ambulance it was so bad :( - couldn't breathe, palpitations, total muscle weakness, loss of coordination and weird vision. It was truly horrible and took nearly two hours to wear off. I would add though, that I do have allergy/intolerance problems with some drugs and also some foods, so maybe most other people will be okay with these drops. I'd also add that that's the day I learned that you don't have to drink a bottle of vodka to get drunk - just put a few drops in your eyes - that was a tip from the paramedic who attended!
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Sorry to hear that Jo000......I've an appointment at Moorfields tomorrow and I want to get the SP on Alphagan drops because the Pilocarpine gives me a splitting headache.

I'm reluctant to have the MPlusses replaced with monofocals so I'm persevering with work-arounds. Interestingly, the national airline where I work has lots of middle-aged pilots who are in the cataract zone, and none of those guys will touch multi-focal IOLs because for them the potential side-effects are a career stopper.

Had I known what I know now (ie the side-effects are far worse than my surgeon alluded to two years ago) I'd have elected for monos, and stuck with reading glasses................ but hey ho; I'm not happy with the thought of having my eyes opened again, with the risks entailed.

I'll post if I get any useful info. Roy
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It doesn't really stop does it? I'm now 20 months post-op and 8 months post laser, and have managed to settle for ambivalence. I'd wondered about eye drops but not really pushed the issue - glad I didn't now Jo!!! - but I'm not sure if they'd have helped. Dale, I think it's fair to say by and large the majority of complaints her are about neuro-adaptation (although as has been mentioned earlier, it becomes apparent that none really understands what that means, if anything). So all I can say is top-up laser does seem to have a beneficial effect - I would imagine this would help you a lot, but you do need to let the eye settle down (8-months to a year post-op) before you play that game. And I have to say any time a surgeon quotes statistics at me I feel inclined to explain to them that I really don't care what 99,000 other people experienced, it's my eyes that are the problem.
So yes, good days and bad days. Distance vision not bad, close up pretty good, middle distance extremely variable, highly dependent on lighting conditions. Apart from the ghosting - which comes and goes - at middle distance i have this sensation of there being a blind spot in my vision, usually associated with people's faces. Just not all the time. To try to separate the physiological effects (which are just weird) from the physiological; one small thing I have discovered not to do is - rub your eyes. I've done this and my vision has been worse for days if not a week after. This probably sounds intensely stupid but it felt like something of a revaluation when I realised it (and stopped it, no more than a fortnight ago). Right now my vision is tending towards better but I feel minor dry-eye and irritation; I can put up with that, because I notice they're coincident with the vision improving.
Night vision: I saw the International Space Station a few times in April, and some much dimmer stars than that. Don't think I'll have a good sense until winter, and I can't guess what that will be - I feel my vision is still changing. Oh, my peripheral vision has been stuffed over the past few weeks - the amount of times I've hit stuff I haven't seen with my hand.
And all that being said. I feel that I've made some trade-offs, and that I may be marginally ahead on points. No glasses, close and distance vision ok, mid-distance problematic but it has its moments. My presbyopia was accelerating, I'm typing this without glasses. I think I just wish I'd waited for the next version of lenses before committing. Mplus - on balance, not a good thing. Best to all.
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Typos: just to say it's not my eyesight, it's the spell checker on my laptop not playing nicely with the forum software!
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Hi Superam, I've not been on the Forum for a while as you'll see, I've been trying to get on with things to see if my sight settles. I'm really interested to see how your eye is now settling almost 3 months post ex-plant? It sounded like a very uncomfortable procedure which left the haptics behind, quite the norm so I'm finding, but as Jo000 said I also doubt they'd do this procedure at all if it was going to compromise your sight even further.
How long had you had the MPlus in your eye before it was removed? I've had mine in 8 months now and still cannot get on with the blurring in lower lighting conditions, shafts of light emanating from any light source, ghosting, starbursts and the 'gold fish bowl' feel, a bit like walking in a kaleidoscope, which stops if I close one eye or the other. I also still regularly see the near edge of the lens which annoys me from time to time. I've started Pilocarpine drops to cope with the blurring in lower lighting conditions, it helps a little, doesn't last very long and sometimes gives me a bit of a headache, apart from the 'cyborg' look to the eye - I have very bright blue eyes and my pupil almost disappears with the drops which makes me look very weird.
I'm seriously leaning towards explanting, can you tell me if you still get shafts of light/glare/starburst affect since having it out?
Thanks Soos
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Interesting you should say that, Peppersghost, - about rubbing your eyes. I often wear make-up and so have to be very careful removing eye make-up because it can hurt - if I press a little too hard I get a weird sensation inside my eye that's def connected to the lens and it makes my eye ache. I'll be more careful about this from now on and see if there's any improvement. And yes I also agree with you, that not being able to star gaze anymore + not being able to see people's faces in low light are the two major difficulties (that's in addition to ghosting, glare and can't drive at night anymore of course!)
And I agree Tyrotrainer - if I'd known the side effects were going to be this bad, I don't think I'd have even had the lenses replaced with monos (I didn't have cataracts). I'd have just had the laser and worn reading glasses like one of my friends did - she's over the moon with the her results and only has to wear reading glasses for small print. 12 months post-op, my near vision is not as good as it was at the beginning and seems to be going worse.
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To Soozie64 and anyone else interested.
Had my explant as explained earlier in thread. Explant eye worse than before, no near vision and rubbish distance vision. Been told it's because of clouding in between lens which Jag treatment will resolve. Due for another appointment next Sat to schedule Jag, but i'm also sure I will need a laser top up to adjust focus. At moment anything remotely close up vision is best seen through Left Multi eye with RE closed. Not great but I've got no other option than to see the procedure through. Soozie i'd wait if I was you with explant, i'll report back my finding when I've had my further procedures done, if that's any use to you. They like stringing you along do OE. I've had to put up with over 2 years of **** vision and i'm not going to take it lying down that's for sure.
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Had my follow-up earlier - my surgeon assured me that Pilocarpine at lower percentages is ok long-term ie one or two drops a day, in order to drive.

I asked about Alphagan - they are weaker than Pilocarpine, so more is required for the same effect. In other words, he said I'm as well off sticking with the Pilocarpine.

As for the headaches (Soozie64) - I am going to experiment with the dosage..... like only a small portion of a drop at a time, until I get reasonable vision. A full drop gives me about 3 hours of useful driving time. If that works I'll try diluting with artificial tears (the surgeon said that's fine).

He offered explantation, however, in my case I think I can live with what I've got; I don't want to risk becoming one of the 1% or so who gets an infection or some other nasty complication..

I might sound totally mad/daft, but I read about the Indonesian free-dive fishermen who can adjust their focus underwater in order to constrict their pupils - they learn at an early age to do it without thinking. I'm going to investigate if it's possible to train the eyes to focus to infinity, at will. Airline pilots do this regularly by focussing on the wing tip (on smaller planes) in order to adjust focus whilst they scan for other planes - the effect is short lived but it works.

Anyhow, good luck all, I hope we all end up with the vision we were originally hoping for.

Roy
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Ah! I wondered if it was just me! It's true, you can actually feel the lenses if you put pressure on your eyes, can't you? Or at the very least the sensation is different to before the op. That's probably not an idea I want to dwell on! The 'not rubbing' thing seems to be at least resulting in consistent behaviour during the day. Starts off a bit naff and blurry, gets dry and a bit irritated, but as the day goes on the vision improves. Right now my distance vision in early evening sunshine is almost a good as when I was wearing rigid contact lenses, close up is good, middle is better than it's been in a while. Curious....
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Thanks for update Superam and I so hope it all improves for you. The two OE consultants I saw around 6 month post-op were both advising me to have an explant but I did feel they were getting a bit fed up of having to supply me with a whole range of different glasses to try and correct the problems. After hearing your story, I'm glad I didn't - though I'm told it is still an option. Let us know how you get on - and good luck.
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Hey Pepperghost.

I know 'statistics' are little comfort to those who have long term problems. I'm still hoping mine won't be a long term problem. I wanted to add a bit to this thread for those who find this thread just a week or two out from the procedure to give them some hope that their eyes may still improve. As my Doctor rightly pointed out, those with good results rarely stop to post in forums.

I hope that I won't have to wait 8 months for a laser touch up if that is what is needed. But I'll know more after my appointment on Wednesday.

Three more observations,

1. The drop hydrating drops that my eye Doctor recommended (Hylo - by Candorvision http://candorvision.com/hylo/ - no prescription required) do seem to help clear things up a bit and certainly make my eyes fell better - less residual throbbing and pain later in the day).  I also think my eyes have improved over the last five days a bit (despite my two year old kicking his toddler soccer ball directly into the affected eye two days ago - OWWWW!!!).

2. While the ghosting seems to be consistently there, my vision does seem to be improving a bit. I'm pretty sure I can now see further out than I could last week. Weird as it sounds, distance items seem a bit crisper even while I still see the ghosting.

3. My eye doctor told me very clearly that the concept of neuro-adaptation is a real thing. Some in this thread said their eye doctors hadn't heard of it. My eye doctor said that my brain might remove the ghosting over time all by itself. She didn't use the exact phrase 'neuro-adaptation' but she used a term something like it. Bottom line, part of the problem, to her mind may not just be physical, it relates too how my brain interprets the signals through the new lens. After all we used a different lens our whole lives and, according to her, for some patients it takes time for the brain to adapt to these lens.

Note: My eye doctor has no affiliation to the surgeon that performed my procedure. It was actually my family doctor that referred me to the eye surgeon (a very reputable institution in Toronto that is a leading provider of such service in the country). My eye doctor had initially referred me to another outfit that didn't have a product for my  needs.

...Dale
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I should also point out that the Hylo drops my doctor recommended are to counteract the negative affects of the  antibiotic (Toradex) drops I still take four times a day and will for another 9 days. She also thinks I may need them for a month or two until my eyse are completely healed from the procedure. They aren't intended to be part of a long term treatment as it seems like the other drops being discussed in this thread are for.  My eye doctor said the anti glare drops (that I stopped last week) and the antibiotic drops can be hard on the eye and part of the vision problem while taking them. The hylo drops are taken no sooner than 15 minutes after the other drops to help the eye clear out their residue. And, as I said, they do seem to help a bit. If nothing else they feel nice when they go in.
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Thanks Superam, I'm 'watching this space', sounds like you are now having a whole new set of problems to deal with. I'm interested to hear about the YAG procedure, I'm needing that now but putting off for as long as possible for explant reasons/options.
Soos
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Hi DaleDietrich
The jury is out on so-called neuro-adaption - I think perhaps it's just the terminology that's misleading. My GP referred me to the NHS eye hospital at Nottingham (QMC). The consultant there told me there was no such thing as neuro-adaptation in vision - basically there are two images falling on the retina, one from the top part of the lens and one from the bottom half. The neural network between your eye and your brain will relay both images no matter what. How your brain interprets that info is still a mystery. We know the brain can add information as it seeks out patterns and  tries to make sense of them, but can it take information away? I don't think so. I think this so-called neuro-adaptation to ghosting is just consciously learning to ignore it - a bit like children are told consistently what 'reality' is, even though they may 'see' things that adults can't/don't - it's called consensus reality. HOWEVER - there are those that claim you can cure eyesight defects by asking for healing in a lucid dream (that's a dream where you know you're dreaming) - in fact I know someone who achieved this and no longer needs glasses. I'm experimenting with that - it keeps me hopeful :)
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Well my eye doctor disagrees with you Jo000. I specifically asked her if this is something I can consciously do and she said specifically that the brain will adapt by itself it it can adapt. She didn't say it would fix radical ghosting. She specifically said I will probably need a LASIK touchup if the eyse don't settle down. But she was very clear that the brain can fix/adjust too some slight issues in some people without any consicous effort. It will either happen or it won't. Since she has been an eye doctor for 25 years and I am not, I take her at her word. She is NOT part of the organization that provided my procedure. She did NOT recommend me to them. She has no dog in this hunt. She is a completely objective doctor who I respect and trust having gone to her for over 15 years.
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My multifocal lens replacement was 8 maths ago and I am as all in this link: glare, halos, distortion etc. The option of exchange to mono focal has been mentioned, at this stage with a near guarantee of perfect long distance vision and no more side effects. That is not what I've read here!!! How are your eyes now?
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Saw my surgeon today (3 weeks post MPlus implant)

- As with my eye doctor last Friday, he was able to correct the ghosting away in the office (though I'm not sure if the light bleeding issue was corrected given the lighting conditions of the exam room)
- He says my eyes may/will probably settle down more over the next few weeks.
- He agrees that the antibiotic drops I'm still taking for one more week could also be playing a part in my poor distance vision
- If my eyes don't settle enough he says he will definitely be able to correct with PRK.
- He says we need to wait three to four months post procedure before we do any PRK to be certain eyes have settled.
- He says my issues are a by-product of my prior 1999 LASIK and that the MPlus lens is positioned perfectly (My eye doctor also thought the lens was inserted correctly).  
- If a correction is needed, it MAY affect the wonderful close-up vision that the MPlus has given me.
- He said that, in that case, he will be very careful to strike a balance between close up and distance in accordance with my wishes (ie: being able to read close up and computer screens are more important to me than perfect distance vision).
- Accordingly he will weigh any PRK correction in favor of my close up.
- All that said he says there shouldn't need to be much of a trade off. With the completely corrected eyes in the exam room I was able to read normal book-sized print.
- My next appointment is Sept 10 to check-in to see if things have improved.
- All of this will be at no additional charge

...Dale
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I have planned surgery in October.  My surgeon is going to use Mplus MF-20 ( this is the same lens as MPlus MF30, but with +2.0 near add instead of +3.0).  This lens is not advertised on Oculentis web site.  Its near add power is somewhere between the "Comfort" lens and the Mplus MF30.

Surgeon  has advised me that I may need reading glasses for fine print, but the advantage is that I will have better intermediate vision and less glare/halos/ghosting compared with MF30 lens.



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That's interesting - the bit about the MF20/MF30. I asked what lenses had been put into my eyes and was told LEFT- Power 15d MPlus Add3, and RIGHT - Power 16d MPlus Add3. In light of what you've written here, that translates into them both being MF30. Why on earth have my surgeons not mentioned an alternative MF20 to me I wonder? They offered only a monofocal explant.
Anyway, please let us know how you get on - though I'm more than a year post-op now and it's probably too late to do anything.
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It might be a matter of timing.  I think the MF20 with the +2.0 near ADD is fairly recent.  
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Hi all
For what it's worth I have booked an appointment at Optegra (recommended by my Optometrist) to consider my different options for my right eye. For new readers I had mplus in left eye a year ago because I have cataracts. I get the afore mentioned halos and glare, but vision is so much better than with cataract, and I have no regrets. Optegta is twice the price of OE, and I have the same budget issues as anyone else. However they offer choices that OE seem to prefer not to get involved with. I am hoping to learn that they do not operate along the same production lines as OE. I will report back following the appointment on 25 September.
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Hello All:

I had my follow-up appointment (2 months post procedure) with surgeon yesterday. I had personally observed that from my last appointment on August 6, my distance vision has become clearer while the ghosting on the left and light bleeding in from the right has remained largely unchanged. I had also noticed ghosting as close as 18” in the last two weeks - ie: when looking at the computer screen there is ghosting of the black letters on the white background and bleed of the white background into the right of the black letters. This is new. I hadn't noticed that back in August.

Here is the results from my visit with surgeon:

- My eye has measurably improved despite continued ghosting and glare (ie: my prescription has improved)
- On August 6 he had measured some near sightedness and a slight stigmatism in my right eye. He said both of those have improved in the last month and have measurably dissipated (ie: my prescription has improved on both fronts). He verbally told me the numbers but I don’t remember them.
- As a result of the eye improvement, Dr  is even more optimistic that my eyes can be corrected without harm to my newly MPlus-improved near vision.
- Dr. believes PRK tweaks should correct both near and far ghosting and bleeding
- Dr. wants to see me again in a month (I have an appointment for October 8). He wants two visits in a row where prescription doesn't change before doing PRK.  He wants to be sure eyes have settled.
- He still believes the problems I am having are a result of my 1999 Lasik. He will be doing PRK correction instead of Lasik correction because he said it is unsafe to do a second Lasik procedure on the same eye.
- It was a very positive visit and he was even more optimistic than on the last visit that I will achieve a good result after PRK (ie: ghosting and bleeding should be history).  

I'll report back after my October 8 appointment.
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I have read with interest all the posts on this thread.  I had my MPlus lenses explanted just over two years ago, but very much wish I hadn't had the first one (R/E) explanted.  I contacted my surgeon at the beginning of the year to ask if he can put the MPlus back because my vision was nowhere as good with mono-vision lenses.  He said he could not do this, but didn't give me a specific reason why.  I therefore tried to find another surgeon in the London area who could do the surgery for me, but no-one was interested because they didn't perform the original surgery.  Can anyone suggest anything, please?  Am I really asking for the impossible?

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All I can do is offer sympathy I'm afraid Lynda. My surgeon wanted me to explant earlier this year (just to stop me complaining about the M-Plus I think) but I decided against it. If I was you, I'd go back to the original surgeon and ask for detailed explanation as to why he can't replace the monovision. I'm guessing it's something to do with the length of time that's passed since your explant. The lenses bed themselves into the eye and when everything's healed up it's very difficult (and very risky) to remove them. However, I did see a surgeon at OE in Nottingham last year who did say he had successfully performed an explant after nearly two years - but if you go down that road you'd have to make absolutely sure that the surgeon was very experienced and had done such an op before. Good luck.
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I posted earlier in this thread that I was planing to have RLE surgery using Lentis MF-20 multifocal IOL. This lens has a +2.0D near (MF-30 has +3.0D near add).

I had the survey on my second eye 2 days ago and I am already free from glasses. Vision is crisp and sharp at all distances. So far (touch wood) I am delighted with the outcome. The only slight observation is that while watching TV if there is bright white text on black background I see a small ghost/shadow of each letter underneath it, giving it a 3D effect.  This by no means bothers me and I had prepared myself to expect it. I have already learnt to ignore it.

The adaption period for this lens is immediate.  I could not have put up with months of waiting while my eyes adjust to the lens.
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This may seem initially off-topic but please bear with me.

I had cataract surgery with OE over four years ago now.  The multifocal lenses from that era were taking and absolute hammering on the forums so I insisted on having the Tetraflex accommodating lens in both eyes.  OE were oddly resistant but I was determined (and paying with £4k of borrowed money) so they eventually (very begrudgingly) gave me what I wanted (though I was given a slight monovision prescription I didn't ask for and which I don't recall being discussed or even mentioned pre-op).

No halos, no glare, no neuroadaptation issues. UV protection as standard. I can read the tiny writing on food packets at arms length under a strong light in our kitchen, kindle Paperwhite at 8-10" no problem, kindle at 4" in bed needs a +1 reader, distance vision is absolutely superb in all conditions. 3D movies, no issues at all.  The only problem with night driving is that my eyes let in so much light now that modern Xenon headlights are very dazzling but there are no noticeable artefacts from the implants.  I am absolutely delighted.

My wife is about to have cataract surgery and is keen to follow my tried and tested path if her eyes are suitable for the same IOL.  We have only been for the first consultation, scans and measurements etc. but we are already getting some push-back about dictating what we want rather than accepting the MPlus lens OE seem to prefer.

I need to be clear: if there is an *objective* reason Tetraflex is unsuitable for my wife then fine, we'll consider alternatives.  I also realise that, perhaps, I was exceptionally lucky.  Just as there are a small percentage of failures like the one's described here there is another tiny group who have an exceptionally good result.  I'd like to be treated like a grown up and told that they switched lenses because they had problems with the one I have or found distinct advantages with the one they are offering now.  Or told they have a range of lenses and a set of rules which dictate the most suitable.

But we didn't get that information, just that, as a company, they have a preferred lens they have few problems with.  Private health is supposed to be about the magic word "choice" so we'd like to choose.  It's not as if we've Googled a lens they have no prior experience with, I can understand the implantation procedures will differ... but it's the same company, same lens and even the same surgeon.

We're having what they call "second consent" when I gather we'll be talking to someone with more detailed knowledge of the available products so I hope we can resolve the situation then.

My questions are these:
Why were OE so reluctant to implant Tetraflex and so keen on MPlus?

Why are informed customers who have done their homework seen as problematic?  It's called "informed consent" after all...

Why are surgeons so obsessed with monovision?  Relying on neuroadaptation is clearly a problem for some patients, it is poorly understood and inconsistent from one person to another.  Both monovision and multifocal lenses rely upon this phenomenon which creates a problem if you make it a core part of your standard operating procedure.

Why is an apparently inferior technology (multifocal) dominating the market when an apparently superior alternative (accommodating) exists?
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Hi there, I would like to think that the reluctance to implant a certain lens has to do with their (poor) prior experiences with it, but there could be other factors involved as well such as commercial considerations. Unfortunately it may be one of the unknowables.

But the general view of accommodating lenses in the ophthalmic community is that they don't really accommodate. It's difficult for the lens to flex if the capsule fibroses and stiffens. The effect of accommodating lenses is unpredictable, and accounts for the usual practice of aiming for 'mini-monovision' with these lenses. The near vision effect of multifocals is much more predictable, and that is why they dominate the market despite the side effects often encountered.

The other unpredictable aspect of accommodating lenses is that they vault, and occasionally if a capsular bag is small or contracts significantly there could be a refractive surprise or a refractive shift.

Monovision is predictable, and importantly, is easily 'reversible'. For example, you cannot easily reverse the halos of multifocals-you'd have to explant and exchange them. Monovision could be reversed with glasses/contacts/LASIK. Many patients have also tried monovision with contact lenses before, so it is something they are familiar with.

There is a reason for everything, and it behooves the doctor to explain everything properly to their patients.
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Pls contact me asap: tomlinson.m(at)gmail(dot)com
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At my November 5 follow-up with Mplus Dr. my eyes had stabilized enough for him to schedule a PRK tweak. It was originally scheduled for mid-January but they did the tweak on Nov 19 following another patient’s cancellation.

There is good news and not-so-good news.

THE GOOD NEWS IS that the universal ghosting I have had at distance was resolved. Also, my distance vision is a tad better/sharper than pre-PRK, which makes sense since my world of ghosts is now a thing of the past.

THE NOT-SO-GOOD NEWS IS that up to this point (3 and a bit weeks later) my close up vision was trashed and I still have ghosting for near-vision on computer screens, books and such. Mostly anything close up with a white/bright background. I have purchased a pair of cheap reading glasses from the drug store. A 2.25 prescription and that seems to work (though not well) for now for close up. I believe that my prior reading glass/bifocal prescription was 3.5 from you so 2.25 is an improvement but the whole point of this $5K and what looks like it will be at least a year long odyssey was to get my close-up vision back. Sadly I have had to reset my iPhone fonts back to super large. I SOOOOOO miss being able to read the fine print on the iPhone and anything else as I could pre PRK. I’m back to using a magnifying glass to read cooking instructions, labels etc.

GOING FORWARD: All is not to despair (yet). Dr. said that once my eyes have stabilized, again, he’ll see if doing another PRK tweak for the near vision loss will make sense. Also, as per the literature, sometimes it takes months for eyes to settle and ‘maybe’ my near vision will return or get better over time. Also, I’m on the last week of using the various eye drops post-PRK and I know from in the past that they can sometimes adversely affect my vision. So maybe post drops things will get a little better. And, also sometimes I do see the smaller print better. So my eyes are clearly still fluctuating some during the day.

If/as my near vision improves I’ll get cheap lower prescription reading glasses to tide me over until this is finally resolved.

Technically Dr. is pleased with the healing post PRK and the MPlus lens. Everything is healthy and going as normal. He says my eyes will keep adapting over the coming months so, as I said there is some hope there. He said the cells on the exterior are likely still healing. He said that if I see better after blinking (as I sometimes do for a few seconds) that that is a good sign. What the tear drops do for a short time is roughly the same as what perfectly healed exterior cells should do over the long term. But even for the short periods post blinking, while better, the close-up vision is near as good as it was pre-PRK.

I asked if I may need the MPlus replaced with a better prescription. He says he knows my Mplus prescription is fine because I was able to see so good pre-PRK. But I’m not sure I understand that. If my eyes are being reshaped for PRK then won’t the lens inside need changing/tweaking. He never actually answered my question as to whether it was possible at this stage to even replace that lens. Some online sources say no – but those are lay people ranting when things went wrong with their MPlus lens.

A few more details/things I wonder about:

- Doctor keeps mentioning that my eye has a slight stigmatism and seems to think this is the source of some of the problems. But if it has a stigmatism didn’t he know this in advance? Didn’t he account for this when setting the MPlus prescription?

- Night time light (eg: street lamps, restaurant signs, headlights etch) and dark room light (ie: in an apartment hallway, in darkened restaurants) sheering is MUCH worse again. But apparently that was expected and should improve over time post PRK
- Ability to see/identify people in the distance (ie: beyond 10-15 feet) when there is a bright background (eg: outside during the day, or inside when in the back of a shop facing the exterior windows with people between) is significantly improved since the generalized distance ghosting is now gone
- I get some bottom ghosting at distances now (before it was all on the left). This doesn’t bother me at all though.

My next appointment with Dr. is set for January 14. I’m guessing I’ll have to go back month after month for a few months until my eyes settle again before any next steps are determined.
BOTTOM LINE: At worst my distance vision will be slightly better than it was pre MPLus because of the PRK and my close-up vision will be slightly better but not at all useful as I’ll still need reading glasses if things do not get better and cannot be corrected further. But there is still hope for better vision going forward. Just need to wait and ‘see’.

So, there we are. I’ll update you again after my Jan 14 appointment or subsequent appointments if/when there is anything significant to report.

…Dale
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