Cataracts

[ed7336]

I had lasik 10years ago on my right eye and have experienced halos at night. I have a cataract and it has been recommended that I am a candidate for the  TECNIS multifocal lens. My question is I have halos now will they increase after the surgery. I understand one of the side affects is noticing rings around lights at night.

[Michael J Kutryb, MD]

If you had hyperopic lasik (which can cause negative spherical aberration) then the tecnis (with negative spherical aberration) could actually worsen spherical aberration.  A Bausch and Lomb LI61AO or standard IOL might be a better choice in this situation.  If you had myopic lasik (which can cause positive spherical aberration) then the tecnis (negative spheical abberation) might be a good choice.  A Zeiss Atlas corneal topography or a wavefront analyzer will be able to give your surgeon the exact current spherical aberration so the best possible implant can be chosen.  The surgeon can use the IOL Master for measurements of the eye combined with the corneal topography readings, he can then use the post-refractive surgery calculators on the ascrs website to pick the best possible implant model and power to try to give you the best result possible.  Hopefully, your visual problems will be better after surgery, but of course you may still need to wear glasses to some degree, still since the lens calculations are never as accurate after having had previous refractive surgery.  That's just the nature of the situation.

MIchael Kutryb, MD
Kutryb Eye Institute
Titusville, FL
321-267-2020
www.kutrybeye.com

[londonbridge]

Dear Ed,
I am not a physician only a patient such as yourself. I was the recipient of a Restor multifocal that I needed to have explanted due to many problems with the visual quality of the lens as well as a mismeasurement. There are many posts on this forum denoting problems with multifocals. I think Dr. Kutryb is giving you excellent advice. I  would seriously consider this advice. You can also read many posts on this forum about problems with multifocals. I think the technology is just not there yet for them to work well for all folks. It is likely  you would need glasses for some tasks even with a multifocal. Monofocals are tried and true and I would reccommend them as well. Good luck with your decision.
londonbridge

[Michael J Kutryb, MD]

Just to add one more thing.  I did not notice that you said tecnis MULTIFOCAL.  I was referring all my comments to the standard tecnis aspheric lens.  The multifocal lens definitely adds a very significant layer of complexity and possible side effects and other problems.  There is no way to "try out" the multifocal lens, so please be very, very  cautious.

MJK MD

[frenchfloaters]

Hi Londonbridge

I had myself cataract surgery 8 month ago in both eyes with MULTIFOCALS IOL . I m not satisfied at all . Too much halos during the night and even the day . I need to wear glasses etc..

My question : did you exchange your implants Multifocals for Monfocals ?

John

[frenchfloaters]

Dear MJK

I am 38 Y old , I had myself cataract surgery 8 month ago in both eyes with MULTIFOCALS IOL acrilisa  . I m not satisfied at all . Too much halos during the night and even the day .Vision is very poor if  the light is low .  I need to wear glasses . Different glasses : 1 for PC , 1 for meeting , 1 for reading etc.. no more accomadation .

the only advantage with multifocal is during the day , when it s very bright . then , i don t need glasses at all

I know there is a risk to exchange IOL , but my question is :

if one of your patient , like me do  not accept the vision of multifocal lens ,would recommand to go for monofocal > how could be my vision in monofocal , if I ll have , one for middle distance and one for long distance ?

Thanks a lot

John

[londonbridge]

I  did exchange my Restor multifocal with a monofocal toric lens. I have been pleased with the result. I set my monofocal lens for mid distance in my nondominant eye and currently wear a distance contact in my dominant eye which is -7.5. I still need glasses for reading. I recently got progressives so that I can correct for my slight astigmatism (-1.25). Eventually I may need to have the minor cataract in my dominant eye done and then I will go for a monofocal set for distance. (Because of the great difference in my eyes currently I cannot wear glasses except for when my contact is in, which can be limiting. This will go away when the second eye is closer to the first.)

With regard to considering explanting. You both need to seriously consider how bad your current vision is with your multifocals. There is no perfect solution and it is quite likely you will need glasses for some situations. Basically, explanting is a more complex and riskier surgery than the initial removal of the cataract and replacement with an IOL. If you go that route please seek several opinions from very well qualified and experienced surgeons perhaps at one of the top eye hospitals, even if travel is involved.
An expert should be able to explant your lenses but you need to weigh the risks against the benefits. If it is a minor to moderate annoyance with the multifocals  than you may want to keep them verses total misery and completely unacceptable vision than consider an explant.
Good luck with whatever you decide. I have a thread "explanitng Restor" and many others have posted here as well.
londonbridge

[frenchfloaters]

Hi Londonbridge

Thanks for your answer . I hope to have some advice from MJK as well .

Regarding my actual situation , I have a lot of inconvenience .  4 differentes spectacles : 1 for reading , 1 for computer ,  1 for driving , 1 for meeting .I almost wear glasses 90  % of the time + halos at night are VERY annoying , and vision at night is very poor . But as you said , I ll have to considerate and think about .
I already took 3 different appointment with 3 surgeon to discuss .

But , from what i read on this board , majority of people are unhappy with multifocales lens and then when they changed , they all of them found an advantage .

Frenchfloaters