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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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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.
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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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I've read this whole thread with great interest as I had this surgery in November (about 12 weeks ago now) and am experiencing a lot of symptoms described here....although to a lesser degree than some. I had no cataracts and am in my late 40s.

I had an MF-20 in one eye (23 dioptres + 2.0) and a week later an MF-30 (22.5 dioptres + 3.0) in my other.

My distance vision is now excellent with no discernable ghosting. Intermediate and near does have this, and this is a bit disappointing for me. I work in the IT industry so spend a lot of time on the computer and would prefer if I had no ghosting. Reading and up-close work is similar.

Don't get me wrong - I can work with it mostly. Certainly for intermediate distance anyway. Also I can get rid of it by squinting (presumably thus occluding part of the lens and removing one image). When I do that, i get a crystal clear image that is stunningly in-focus and detailed.

I have no plans to do anything much about this - prepared to give it plenty of time for the elusive neural adaption...so we'll see how that goes.

Overall I'm quite happy as I've got rid of my glasses. I can drive a car and motorbike in all conditions day or night (not at the same time) and generally walking around on the street have excellent vision now. Colleagues of mine still wearing glasses are amazed at how I see now compared to before.

I also have experience of my inter and close vision being different at different times - often depending on how tired i am etc...as others have mentioned here.

As I said, I'm adopting a wait and see approach, and hope that in a year's time, I'll either be so used to it that it no longer matters, or that something will have changed otherwise. At the end of the day, I could live with it like this...but would prefer it to be slightly better.

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All interesting comments and versions of what I'm experiencing . I had Mplus30 lenses fitted in December and whilst I have great near vision , low light vision is near on impossible . Strangely enough if I hold my head back and look through the bottom of my eyes it's perfect ?

I have had so many appointments with  specialists and now 2 OE surgeons . These 2 surgeons actively put these lenses in , in 180 deg differences , when I inquired as to why the surgeon who is doing my follow up issues said it's to negate the symptoms I am experiencing . I have contacted both OE and Oculentis for a reason why this would be and strangely I haven't had a reply , a lens rotation is my only option .....
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I'm now 2.5 years implantation and still get halos but the star burst effects have pretty much gone.  I had a top notch surgeon at Moorfields in Dubai and he definitely was not a salesman, but he did explain the risks, and he WAS a believer in neufo adaption.  After a year I was so frustrated with my awful night vision that I was close to asking for explanation.  He said he'd do it but he felt strongly I should give it another year at least... up to me.

I'm so glad that I did wait.  My daytime vision is still awesome. .. like a hawk. .. watching TV used to be awful unless the room lights were full up,  driving was scary unless I used Pilocarpine drops... However now the night time effects are greatly diminished and I never notice ghosting or halos UNLESS look for them,  and my depth of field is ok.  I now drive at night without using drops, but I must say that my vision is nowhere near what it was at night pre-op.

I think explantation is a massive decision to make and a very personal one.  My experience is that I got scared after 12 months and almost went for lens replacement,  but I am now SO relieved that I stuck it out. I have a bad feeling about pushing one's luck when operating on the eyes.

Hope that helps the discussion.

Roy
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I'd just like to clarify my last because I know that people would like to know exactly what happened to other people, and I didn't explain fully my before /after.

Before I had below average distance and needed reading glasses, the reading glasses were getting stronger with age,  but even with them I struggled with small print less than say font size 8. Night vision was ok.

After I have amazing distance and reading vision in good light...I can read the tiniest print on food packets etc without glasses... easily below font size 8, but only in good light.  In poor light I'd say I'm now around the level I was pre-op but with halos.  

I am definitely improving gradually,  overall I am extremely pleased with my outcome.

Roy
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Please see my comments below. ...I think you will be very pleased in 2 years time. ... your mindset is exactly same as mine and I am improving ever so slightly every day.
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I had IOL replacement surgery for my cataracts two years ago.

I got a Lentils Mplus +3.0D in one eye and an Mplus (comfort) +1.5D in my dominant eye.

It has worked very well and I can see all distances clearly without glasses.

Initially I noticed a little bit of ghosting at night for bright things like streetlights, but over time it reduced greatly. I guess if I look for it specifically at night in high contrast situations it is still there but my brain doesn't trigger any abnormalities any more.

They didn't have the Mplus +2.0D at the time but the 1.5 and 3.0 have combined really well together. It doesn't feel like one eye is doing the work for reading and the other for computer/intermediate - both eyes work like one.

I've basically forgotten that I even have IOLs. Very happy overall.

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thanks for the update; glad it has all worked so well for you.  I am still waiting - my other cataract is not too bad yet, so no rush for me.
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Hi, I'm an ophthalmologist and refractive Cataract surgeon from Indonesia. I'm very happy to find this discussion.  
1. I would like to say that there is no artificial lens (implant) that perfect. Every implant, multifocal, monofocal, have advantage and disadvantages. This is important to discuss with doctor. He/she will help you choose the right implant to suit your need. This will be a long discussion, maybe more than 1 appointments.
And for now, oculentis M plus is the best multifocal implant in the market compare to other lens.  Maybe in the future, technology will bring us better lens.
2. Neural-adaptation is real. Having multifocal both eyes in short distance time of surgery will help Neural-adaptation. It's like watching 3d movie with glasses. Rig Rig will see red image, left eye will see green image. But with both eyes brain with fuse this image into 1 3D image. With multifocal implant (like Mplus), right eye will see a slighly different image with left eye, but wit both eyes brain will fuse both image into one good  image, and ignoring the not important image l ghosting, hallo,etc. Yes, it still there, but your brain will ignore it.
It's the same principle with your skin ignoring the feeling that you are wearing clothes. Because it's so routine...
I hope this help. Sorry for my bad english.
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