Explanting ReStor IOL

After going through three months of blurry vision at all distances with my left eye ReStor IOL., I took the advice listed on this forum and submitted an Adverse Medical Report to the FDA. Imagine my surprise to find 50 pages of reports, over 500 of them associated with this lens. Most of them were for my model lens as well. All had similar problems to mine and none were resolved by Yag laser capsulotomy or PRK lasix to fix the power. I understand once they do the Yag it is much more dangerous to explant. Three doctors have confirmed that my capsule does not look blurry and contrary to the typical events, my vision after surgery hasn't changed, verses becomming blury later like most capsule problems. My current doctor recommended a piggy back lens for the power, which he claims is off due to measurement error. This type of procedure is not recommended by the manufacturer of the lens. I sought the opinion of MASS Eye and Ear, a world renowned facility and they said that there were risks in explanting my lens.
So now I am faced with a life of blurry vision that can't be corrected with contacts or glasses. I currently wear a contact in my "good eye", which is -7.5 with a small cataract, a +2.5 in my operated eye to even out my vision so my mid distance isn't half in and half out of focus and reading glasses! My visual handicap was better before the surgery when the only thing I couldn't do was drive at night, which I did any way.
The other alternative appears to be an explant of the left eye, continuing with the right eye wearing a contact. What are the risks of an explant? Would you replace the Restor with a monofocal for far distance and get a far-intermediate contact lens for the right? Acylic verses silicone, which is better?

[JodieJ]

In your place, I'd have the ReStor explanted by a surgeon who was very experienced doing this procedure.  I'd let the surgeon choose the IOL and the material (after expressing my preference for an aspheric monofocal lens).  If my left eye were dominant, I'd target good distance vision.  If it were non-dominant, I'd target either good intermediate vision (modified monovision) or good near vision (full monovision).  (If you've never done monovision, the modified version would be a safer choice.)  Best of luck.

[John C Hagan III, MD, FACS, FAAO]

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[londonbridge]

Sorry but I did not see a comment posted.
londonbridge

[John C Hagan III, MD, FACS, FAAO]

I don't have an opinion on this. Risks including infection, bleeding, retinal detachment, macular edema, continued dependence on glasses, and ending up worse than you are now.  Jodi J has as she always does, given a good advise. I would not put a multifocal IOL in the eye.

JCH MD

[londonbridge]

Thanks for your advice. I saw another group of doctors assoicated with TLC Laser vision center in Fairfield CT. They did Tiger Woods eyes and have much experience with multi focal lenses. They, like Mass Eye and Ear are recommending leaving the Restor in place since it applears well centered. and doing the Yag laser and fixing the astigmatism with another procedure. They claim they have done this a lot which very good results and it is safer than removing the lens.  Then they will make recommendations for my second eye, which currently only has a minor cataract and is a -7.5. I am not sure if I will get good vision with the two eyes still being so different, one multifocal and one non implanted. But I need to do something since my IOL eye is only 20/50 with blury and doubled vision.

[John C Hagan III, MD, FACS, FAAO]

Good luck.
JCH MD

[londonbridge]

Thanks. I guess I didn't realize that Jodie J was one of the doctors. At any rate I now have an ulcer on my cornea from wearing the right contact too long and I am left wearing my glasses only with vision for one eye. Very frustrating because I cannot drive to my business trip and my husband has to drive the three hours to New Hampshire. I am a very active 54 year old and feel so disabled by all of this.
Fran

[JodieJ]

No, I'm not an eye care professional--just a patient like you.  I've had several eye problems myself, for which I did a lot of my own research, learning a great deal in the process.  Sorry to read about your corneal problem--I've had similar problems which always resolved.

[John C Hagan III, MD, FACS, FAAO]

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[SBedsole]

Restor works best once both eyes are complete.  Restor in my experience is more influenced by capsular haze because of the optic.  Maybe you just need a YAG and will be ok.

[John C Hagan III, MD, FACS, FAAO]

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[londonbridge]

Thank you for your support. At this point I am leaning toward the YAG because of the reason you subbested. My concern was if that didn't work I would be stuck because of the difficulty explanting the lens once the capsule has a hole in it due to the YAG. The group I went to in Fairfield CT felt I would still have options for an explant and they have done them. However they do feel the YAG would help and could also try other procedures for the astigmatism. After I did the Restor and had problems I went to several well regarded experts who did not feel the right cataract was significant, which may have caused me not to do the Restor in the first place, due to having them work best in pairs...Oh well. At the moment I am dealing with a corneal ulcer on my "good, bad" eye from wearing a contact lens so that I could at least see to work. I will never take my eyes for granted that is for sure.
Thanks again.

[JodieJ]

In your place, I would not get a YAG.  Based on all the information you posted on 10/14/08 (above), there doesn't seem to be any reason to believe that you need or would benefit from this procedure.  I get the feeling that when the outcome of multifocal surgery is disappointing, some doctors automatically do a YAG.  Many people have posted here that there was no improvement in multifocal vision post-YAG.  And this procedure does increase your risk of retinal detachment (in addition to making an explant more complicated.)  So please think twice before proceeding.

Even small amounts of astigmatism have been reported to impair vision with ReStor.  How much astigmatism do you have?  Does astigmatism correction improve your near/distance vision during an eye exam?  If it doesn't, it's likely that a refractive procedure to reduce astigmatism won't help either.

For some people posting here, multifocal vision does improve with time (i.e., neuroadaptation).  But this is certainly not always true.  I've been reading this website for almost three years, and I can only conclude that multifocal IOLs simply don't work for many people.

I still think that explanting your ReStor might be your best bet.  Yes, this invovles more risk than a YAG plus a refractive procedure to reduce astigmatism.  (Yet it is not terribly risky when performed by an expert.)  BUT COMPARE THE LIKELY BENEFITS OF THE TWO OPTIONS.  Everyone posting here who has had their multifocal IOLs explanted and replaced with monofocal IOLs has been delighted with their outcome.

I know from personal experience how frustrating and anxiety-provoking vision problems can be.  I hope your problems are soon resolved.  

[londonbridge]

Thank you once again for your comments. I went to a local Opthamologist for treatment with the corneal ulcer. He is rather conservative compared to the TLC group and agrees not to do the YAG and to do the monofocal explant replacement. It is a good idea to confirm whether an astigmatism correction actually helps. I have had multiple eye exams to date and don't recall seeing any better with restor lens no matter what correction was tried.
In addition several doctors do not feel my right eye cataract is very much at all so it is doubtful I would want to do another Restor, at least in the near future. So if I correct the Restore with Yag and lasix, I would need to find what can work in the non operated eye.
My non operated eye is dominant, so I take it I should correct it by contacts (which I may not be able to wear due to ulcer problems) or glasses. If I choose a far-mid distance monofocal I am not sure if glasses will work with my right eye being a -7. I am not sure if you follow all of this, but if you do I would once again really appreciate your advice.
London Bridge

[JodieJ]

Londonbridge, if you are unable wear a contact in your unoperated eye, you will probably have to have your right eye done sooner rather than later.  (Some soft contacts can function as a bandage while providing correction; check out whether this would be a possibility for you.  And your cornea will heal in time.)

Most people cannot adjust to a difference of 3+ diopters between their eyes (unless they wear a contact lens).  If you wanted blended vision (distance vision in dominant eye, intermediate in non-dominant eye), you'd replace the ReStor with a monofocal IOL targeted for -1.25.  Glasses wouldn't work with your dominant eye -7; you'd have to move up the second surgery or wear a contact.

Unless you're happy with your first ReStor, don't get a second one!  If glasses/contact don't improve your blurred vision, it's very unlikely that LASIK will help.  Possibly (but not necessarily), your vision will improve with time (if you have the patience to wait and see.)  According to the professional literature, neuroadaptation to multifocal vision can take up to a year.

[londonbridge]

Thank you once again for your patience and advice. I really appreciate your taking the time to help me sort through all of this mess. The idea of the bandage contact is a good one. (It may allow me to at least go back to where I started and be able to drive and work. I am not comfortable at the moment driving on the highway with my restore eye blocked out using only my glasses in my right eye with the ulcer! My job involves travel, which is one of the reasons I did the cataract surgery in the first place!)
It also sounds as if glasses are not an option with a -7.5 dominant eye and a corrected monofocal IOL eye. My question is this. would it help to have the nondominant eye set for an intermediate distance or is that still too many diopters different (sounds like it still is) And if I am able to tolerate contacts again does it make sense to do the nondominant eye for distance and wait to do the dominant eye using a contact for the intermediate. How important is it to do the dominant eye for the far distance. I guess a myopic person who always struggled for crisp distance doing the first eye ( non dominant) for far distance has some appeal. At this point I don't believe I will do the right eye in the near future unless my cataract really progresses. I can see fine with the contact (20/20 for distance in it. and after so much misery I am very reluctant to do anything with my other eye that is unecessary.

[JodieJ]

Most people prefer using their dominant eye for distance.  I used to do monovision with contacts, and I found that either eye worked for distance vision.  But setting your non-dominant eye for intermediate vision is probably the safer choice--ask your surgeon about this.

You're correct--glasses won't work with one eye -7.5 and the other -1.25 (good intermediate vision).  A contact works fine for most people.

I can understand your reluctance to proceed with your right eye given your bad experience with your first surgery.  My own experience with cataract surgery was very different from yours.  I developed a rapidly progressing cataract in one eye only following retinal surgery.  My vision was good enough to watch a subtitled movie at the theater a few hours after receiving an aspheric monofocal IOL.  (I got an AcrySof IQ; I wore a contact in my unoperated eye.)  I was so pleased with my first outcome that I decided to get an AcrySof IQ in my second eye rather than do LASIK.  (I was highly myopic like you.)  If you haven't already seen the patient information video at www tecnisiol com, you should check it out.  Both the AcrySof IQ and the Tecnis monofocal claim to improve night driving ability, and my own experience suggests that there's a real basis for this claim.        

[londonbridge]

Thank you once again for your help. I will check out the video on the technis monofocal. Did you second IOL have a cataract at all? I have a consult by phone with the Retinal specialist team that I saw at Massachusettes Eye and Ear a few weeks ago. Of all the people I have seen they did the most thorough work up and I trust them.
(I am obviously still struggling with whether the Restor will ever work. The TLC Laser center in Fairfield indicated that they could not tell what type of correction they would need to do either by Lasix or Limbal Relaxing Incision until they did the YAG. because everything will still look blurry due to the wrinkled capsul. It seems as if they should have an idea based on just an office refraction with simple lenses.)
Thank you again. I hope to move closer to a resolution.
londonbridge

[JodieJ]

Get a second opinion before doing the YAG.  This procedure does contribute to the risk of retinal detachment (in addition to making an explant more complicated.)

I didn't have a cataract in my second eye.  My vision with an aspheric monofocal IOL was at least as good (and probably better for night driving) as my best corrected vision pre-surgery.  That's why I'm such a big fan of this type of lens.

[londonbridge]

Hi Jodie,
Thank you once again for your kind help and that which you give to others.
I saw my local Opthalmologist today and my ulcer, thankfully, is resolving but still not well enough to wear contacts again. ( I may switch to a daily wear if I can go back to them). He also gave me the advice to have the Restor explanted and replaced with a monofocal for all the reasons you and others have recommended. He has another group in Boston that he highly recommends, which would be the third specialist opinion, but I doubt it could hurt at this point. Erring on the side of caution has never been my strong suit, and perhaps is not a bad idea. ( I regret not having sought more opinions prior to this mess already, but of course I put my trust in our family eye doctor of eight years...)

I also had a phone consult with Mass Eye and Ear. They pointed out that my two eyes will not work properly together no matter which IOL I choose without a contact or second surgery, so that issue is resolved, because it doesn't play in to my choices with the first eye.. They definately would not implant a second Restor, but if I kept the first Restor they felt they could do a monofocal with it if I needed surgery. If they did a monofocal they would either do distance or if I was adamant about not wanting the other eye done and could not wear a contact either, they would make the first eye -6.0 to match the other near sighted eye (this seems like a bad choice if I am already needing to have a lens in the left eye). They felt it was possible to do the YAG and lazer correct the Restor to perhaps 20/25 of course no gaurentees and no statistics available on how often this works. They repeated not to do the YAG if there is any chance I would not keep the Restor (so that issue is settled too).
So I am working on healing my right eye ulcer, maybe trying to drive with only that eye with my glasses ( the left lens has a fogged out glass in it) and having a third opinion on the explant verses Yag and Laser for the Restor. I believe I am getting closer to a resolution and am leaning toward the explant if I can find a competent surgeon, which I believe I can up in Boston. (Still a part of me that wants to explore fixing the Restor but I would need to be much more certain of the likelyhood of success before choosing this option).
I have also filed adverse event reports with both the Alcon Company and the FDA regarding my experience with Restor and I encourage others to do the same. They need the data on these problems.
Thanks again for "listening"
Fran

[JodieJ]

Don't even consider making your first eye -6.0!  I can't imagine why anyone would suggest such an option.

I think blended vision (distance in dominant eye, intermediate in non-dominant) is the optimal correction for most people.  With a little luck, you'd only need glasses for prolonged reading or tiny print.

If your ReStor vision can't be improved with glasses/contact lens, then LASIK probably won't work.  

If you don't need astigmatism correction, you might consider trying a 1-Day Acuvue Moist contact.  This has to be the most comfortable contact I've ever worn.

Have faith that your ordeal won't last forever, and your vision will improve.

  

[londonbridge]

I think the suggestion to make it -6.0 was in response to my saying I didn't want any surgery on the right eye and I couldn't wear a contact and needed to rely on glasses. In that case the only glasses that would work would be if both eyes were nearsighted. This is not the option I would choose. I hope I can return to a contact in my right eye.

I am trying to gather more information about the possibilities of fixing the restor as my family is urging me not to undergo the risk of explantation. I suppose insuring that I could achieve some correction with a contact or refraction would be reassuring before doing laser. The problem seems to be a Yag laser would be done first and then the refractive laser, which obviously increases the explantation risk. ( I know I have been all through this before and I am driving myself and anyone else crazy)

Anyhow do you know where I can find out the reputation of The Boston Eye Center (Dr. Samir Melki) and TLC Laser Vision ( Dr. Eric Donnenfeld). These are the two people I contacted so far who could do either explantation or Yag and laser. They lean toward not explanting.
thanks again
Fran

[JodieJ]

If these doctors are board-certified and have been in practice for awhile (www.aao.org), these are positive signs.  You could check for malpractice suits (probably with the appropriate state agencies.)  I tried both names on www ratemds com; Dr. Donnenfeld had one very negative patient comment, which is difficult to evaluate without more information.

Please re-read your initial post on this thread (10-14-08).  You have listed several good reasons why you would not benefit from YAG.  Why are these doctors insistent that you have it?  Unless they can come up with a reason that makes sense to you, I would question their competence.  (As a formerly high myope who has had cataract surgery, your risk of retinal detachment is already slightly higher than the norm.  Why add to this risk for no good reason?)

It's my impression that the risk of an explant is about the same as the risk of cataract surgery--no higher.  

[londonbridge]

Thanks again. Still weighing all my options. My ulcer is healing so I hope I can try the contact again. For now I can not drive anywhere which is a big handicap for me since I am on the go 24/7. I will check credentials of both docs some more.

[londonbridge]

I went back to my local eye doctor today. The ulcer is healing but still cant wear the contact so I still can't drive. He suggests seeing another specialist in Boston and he still recommends explanting the restor. He was able to correct my vision to around 20/25 in the office in the restor eye, so I suppose that tells me I could have laser to correct the vision, although I did not find the vision crisp.  He again confirmed he did not see a cataract in my other eye. Leaning again toward explant. So very confused and frustrated. At least I still have options. He also found that my current perscription in right eye is not adequate in my glasses. (despite the original surgeon telling me that no correction would help because I had cataracts and in fact would have made it worse). Oh dear. Anyhow my saga continues.

[JodieJ]

Having 20/25 distance vision with ReStor is quite good--actually about as good as it gets with this lens.  If it's possible, you could try wearing a contact in your ReStor eye to see what LASIK might do for you.  (Don't expect your vision to be as crisp as what you once had.)

It was my experience that stronger glasses greatly improved my vision in my cataract eye, at least initially.  I don't know why your surgeon told you otherwise.

You will be so much more comfortable once you can wear a contact lens again in your right eye.  Then you can relax and assess your options.

[londonbridge]

Thanks. You are a very caring person to take so much of your time helping others. You fill a true need for people.
The only contact that I tried with the Restor eye was one to give me mid distance so as to even out the two eyes a little. I had ordered contacts in this strength for the left. I will see about trying a distance strength, perhaps just try the right lens on the left to start, although it seems like I have astigmatism in the left ( maybe from surgery) and not the right. It is worth a try.
Still weighing my options. Is it true you can get a monofocal with astigmatism correction, if I go the explant route.
Take Care,
londonbridge

[JodieJ]

Yes, there is a monofocal IOL with astigmatism correction--the AcrySof toric.  It's supposed to work well if you have more than a diopter of astigmatism.  Limbal relaxing incisions (which can be done in your doctor's office) also work well if your astigmatism isn't severe.  (I suspect that yours is mild.)  LASIK is supposed to be the most reliable way to correct astigmatism.

If the power of your ReStor is a little off, it should be affecting both your distance and near vision, since the ReStor is a bifocal lens.  At least in theory, a contact lens which brings you to 20/25 distance should also improve your near vision.  If your doctor stocks different contacts, you could try out different powers in the office to see what works best.  There are many brands of disposable toric contacts which eliminate astigmatism.
Hopefully, your right eye is almost ready to wear a contact again.  You might try a 1-day disposable contact (like 1-Day Acuvue Moist) in your right eye initially; it's more comfortable than a conventional soft contact (at least for me.)

[londonbridge]

Thank you again.  I did try an astigmatism contact in my Restor eye, which was mainly to even out my eyesight and give me some mid distance. It helped some but I found it wasn't enough to want to wear it all the time. It made my distance vision blurrier which I think made it less distracting. I have not tried a prescription to see if I could improve the close or distance vision with the Restor eye with a contact. In the doctors office as I said I was able to get 20/25 distance, but it was a strain and not the clarity that I would like. I also find not having mid distance very difficult for daily tasks.The contact for my left, unoperated eye, was an Oaysis by Alcon and it was very comfortable, the best I've tried. I suppose I over wore it because it was the only way i could see! Perhaps a daily wear would have less complications.

Any way I have a third appointment with someone recommended by my family doctor. After that I will try to make a decision. I am leaning again toward explanting the Restor. I really long for crisp vision at some distance, preferably far to mid. I realize either way I am stuck with a contact and glasses for a while at least. What is holding me back is fear of the risks of explanting. Part of me feels I should play it safe and keep what I have, but that still means the Yag and lasix and maybe a limbal relaxation incision each of which carries some risk. So I am still unsure, but feeling like there will hopefully be a good resolution.

[JodieJ]

I know what you mean about missing intermediate vision.  I have some soft bifocal contacts, which I rarely wear anymore because I hate having distance and near vision only.

I had limbal relaxing incisions at the time of my cataract surgery, with good results.  There is little risk if you're a good candidate.  (Most people are.)  YAG increases the risk of RD slightly and makes an explant more complicated, but it is very quick and totally painless.  I've never had LASIK; my greatest concern would be dry eyes, since my eyes are slightly dry already.  An explant carries about the same amount of risk as cataract surgery.

I still think that you would be happiest with aspheric monofocal IOLs set for blended vision.  These lenses provide crisp vision, and the best night vision.  With a little luck, you would only need glasses for prolonged reading or seeing small print.

[londonbridge]

Yes this is where I am leaning and I hope to make a decision after talking to the Boston Mass Eye and Ear again and maybe another opinion. My main concern would be insuring that the surgeon has done many explants of the Restor and is confident about doing this with minimal risks.
Thanks again for your patience including repeating advice over again. It seems from reading other posts that when it comes to your eyes, especially after having a negative experience, people are nervous and cautious and like me waiver back and forth.
Fran

[londonbridge]

Hi Jodie,
Its me again. Well I am now back to wearing my contact which helps. The ulcer is healed, but I do have scar, but thankfully not over my pupil. I went to MAss Eye and Ear yesterday fully prepared to begin discussing an explant of my Restor. However they seem to be less inclined than previously to do this. Plus the doctor I met with there, a world reknowned surgeon said that he has only explanted one other restor before. They are trying to use a contact over my Restor eye to see if it can be corrected for distance (that is the eye that was very nearsighted and now is farsighted due to the wrong measurements prior to surgery). They are wondering if my "problem" is due to the discrepency in the two eyes. (Previously they only wanted to focus on my Restor eye) As far as I can tell while I can get to the point of reading letters on the chart, the vision is never crisp or clear. Still very frustrated. Several local doctors that I saw regarding my ulcer and for a second opinion think I should do an exchange but the specialists/surgeons I have seen appear to be in favor of fixing the Restor with laser etc etc. Very frustrating but not ready to give up just yet.
Fran

[Lerbea]

I was told that laser would correct the eye if any refractive error was present with the Restor IOL.  Laser is done as I understand to correct the eye permanently for the refractive error. After wearing glasses I realized that neither the glasses or the laser would correct the ghosting and blurry vision. I've chosen to replace the Restor

[JodieJ]

Fran, don't ever give up.  If a contact or glasses can improve your vision with ReStor, that's an excellent prognostic sign.  However, if your best corrected vision is still unsatisfactory, it's probably time to consult a surgeon who is experienced doing explants.  In your place, I'd ask for a referral.  (I'm sure that a highly respected doctor at Mass Eye and Ear is aware which area surgeons have such competence.)  Please don't agree to a second ReStor if you're not happy with your vision with the first one.      

[btdawgh]

WOW...just when I write my question...explaing how confused I am ...I read here and now I am "really" confused....
...Anyone have a dr. they trust in Houston area ??
This constant scratching in my eye is going to make me NUTS...or at least Nuttier then I am at the present time....
Someone just step up and TELL me what to do please.

[Lerbea]

Find a teaching hospital/ university to consult with. They know more about all the products and problems.

[londonbridge]

Thanks once again for your comments. I definately do not plan to get another restor for my unoperated eye. Trying to see if i can get acceptable vision with the Restor eye and a contact. It seems to me no matter what the two eyes do together, I should be expecting to satisfactorily correct the Restor eye with the contact prior to agreeing to any type of laser. Do you know if laser can be done for refraction without doing the Yag first (as seems to be the protocol with these things) I am very reluctant to do the Yag for reasons already discussed.
Lerbea.. Did you have laser to correct the refractive error or just decide that it wasn't going to help based on your experience trying refractive correction with glasses? It is frustrating how doctors interpret my responses to the eye chart. If I give any indication that I can see the letters, some doctors take this as adequate vision while to me it is not what I expected my vision to be corrected to after cataract surgery. I am definately learning patience here.
Thanks again,

[aleif]

Hello everyone,
It has been about six weeks  since my cataract surgery, ReStor lens and 2 weeks after YAG. I did the YAG because there was significant capsular darkening   confirmed by second opinion. My vision is improving very gradually, but when I tried to resume full normal activities I found it to be not dependable enough. Glasses help me, although I have not progressed to an up to date prescription b/c there is too much change. I think the drops (PredForte) while necessary (they prevent uneven healing and dislodging of the lens) do cause vision blurriness, as my improved vision is directly a result of tapering off of medicine as directed by the doctor.
My perception of the whole issue—cataracts and IOLs has changed. This is serious surgery. Everyone knows someone who has had cataract surgery and it was “no big deal”. Since most of those persons (statistically in their 70s and 80s) are generationally taught not to complain and may be coming from blindness—naturally they say everything is OK. Persons who I have talked with in their 60s would love to have something better—but I cannot in good faith recommend these lenses. My doctor just shook his head when I suggested ReZoom, and my 2nd opinion (one of them, just said no way he would be involved in ANY of them—too risky).
It seems that younger people with cataracts are problematic. I am 53, and I had LASIK with success for about 7-8 years.  There is so much hype. That Tiger Woods certainly does get around…he trusted his multimillion dollar eyes to each doctor in a franchise? He lives in CA and FLA so what is he doing in DC and CT? Maybe one tiny little zap for the legal department—so he can say he did something—but I think this is mostly about endorsement, not about a real life regular persons eyes and problems. He is also very young.
The hype on IOLs is pretty intense also. Even the names are an endorsement. Why do the doctors push them so hard? When you hear about the results…works somewhat after this, this, this, this plus this—and paying for each thing as you go along. Repeat customer--the basis for all great businesses. More importantly, each procedure has risks and leaves scars which make it more difficult for you to improve later with other technology. The FDA approval is rather thin also. You can check that on the website. Why does it need so much “touch up?” I have had many surgeries, no touch ups (except this one.) I think it all points to technology which is not ready for general use. I certainly would not subject my other eye to further procedures.
My conclusion is that cataracts in younger middle aged people are a life issue to overcome and not a simple matter at all. Good luck to all who are going through this.

[JodieJ]

I know from personal experience how stressful vision problems can be.  I understand why new glasses would not be practical for you at this point.  However, if you're not contact lens intolerant, wearing a disposable contact might be very helpful.  (My optometrist generously supplied me with disposable contacts in various powers when I was in a situation like yours, and it helped me a great deal.)  It sounds like your vision is slowly heading in the right direction.

It's been said before that the technology of today's multifocal IOLs cannot live up to patients' expectations.  In addition, multifocals seem to be intolerant of even minimal refractive error, requiring additional touch-ups.  However, my experience with aspheric monofocal IOLs was SO different from yours.  I was about the same age as you when I got a rapidly developing cataract in one eye following retinal surgery.  I was very nearsighted and got aspheric monofocal IOLs implanted in both eyes.   My post-surgery vision was good from the beginning, and I've never had any problems (i.e., glare, halos, dark arcs, etc.)  That's why I keep urging others to consider these IOLs.    

[aleif]

Hi Jodie
Thank you for spending time to correspond with us as we go though this experience. It is very stressful and time consuming. How do you resolve the middle and near vision issue with your monofocals?
The results of my follow up yesterday with my original surgeon are: 20/25 far; 20/30; near with heavy ghosting; no astigmatism. Intermediate vision is good, something I have not enjoyed for quite some time. About +2 improvement from my previous result. I think for me the ghosting will eventually fade, although my vision will never be very crisp in that eye. Contacts are out for me due to mild dry eye. He admits the power is off by .75, but still feels the surgical risks to correct this are significant. He wants me to get another opinion (scheduled for mid and late December) before going forward with anything. The cataract in the other eye is mild, so I have some time before I need to make a decision.
These are very tough decisions to make. You take a gamble that your vision will be compromised permanently, or you will need invasive multiple surgeries. The ethical issues in this are disturbing to me, particularly in light of the FDA findings. I wish and hope good results for all struggling with this. Aleif

[JodieJ]

Your mild nearsightedness has one benefit:  You have good intermediate vision with ReStor!  If you do decide to get a second ReStor (set for near plano), you could end up with a very nice range of vision with both eyes.

It would be to your advantage to know whether your near vision could be improved with the correct power ReStor.  I have dry eyes, too, but have no problem wearing a 1-Day Acuvue Moist contact in one eye.  (This contact stays moist no matter what you do.  When my eyes get very dry at film festivals, the one with the contact lens actually does better than the one without.)  It would be worth trying this contact in a -.75.  Alternatively, you could try reading with trial glasses in your doctor's office.  I suspect that a minor power correction would make a big difference in your vision.

There are several alternatives for getting near/intermediate with monofocals IOLs.  These included monovision, blended vision, progressive glasses, multifocal contacts.  

[londonbridge]

Hi. I have been wondering how you have been since  our situations are so similar. I too am so very glad I did not proceed as my original surgeon reccommended with a piggy back lens and a second Restor following my poor results in the first eye. I have seen specialists in Fairfield CT, (the Tiger Woods People) and Dr. Melki at Massachusetts Eye and Ear Hospital ( one of the "top ten eye hospitols, per this website). Both have recommended Yag for me followed by a touch up with either Limbic Relaxing Incision for a minor astigmatism (.75) or lasix to correct my moderate nearsightedness caused by the Restor being the wrong power. My eye that still has the slight cataract is -7.5. I have been trying various combinations of contacts but as I reported previously cannot wear them too long each day due to an ulcer. I find the toric lens for my Restor eye ( an experiment from MA eye and ear to see what my vision could be like with the touch ups) to be much less comfortable than my right eye without the toric lens. Either way I need glasses for intermediate and near plus the contacts ( much worse in my opinion than the cataract with no line bifocals as before).
I have to agree with you that younger people, I am 54, should seek multiple opinions before proceeding with any eye surgery especially multifocal IOL's. I also face either invasive surgery to remove the IOL or settle for touch ups that will still leave my vision not very crisp or functional for night driving, the very reason I decided to have cataract surgery in the first place!  I also urge them to study the FDA website. They will see that the approvals for these devices are based on not very many patients at all compared to the number of people having these implanted.
I have had several, local, well regarded eye doctors recommend removing the lens. However none of them wanted to be the ones to do this. Whereas the experts are all gung ho with the Yag and touch ups. Interesting.
Well hang in there. Keep us posted in the forum and I will do the same. I see Dr. Melki on Monday to discuss how I did with the contact over my Restor. It helped some to even both eyes out for distance but the Restor eye by itself still had not great vision.
LondonBridge

[aleif]

Just wanted to say a big thank you all for your support. Like many medical conditions it doesn't lend itself to small talk, or even with friends...too complicated. Tomorrow I am seeing a new doctor, so hopefully will have some answers then. At Thansgiving dinner with friends one relative asked me about IOLs--she wanted so much to see more comfortably. There was so much hope there that these lenses are the answer...I just had to say, "Not these! Unless you have very bad vision and want to take a big chance..." It just made me more aware of peoples longing for better vision. Aleif

[londonbridge]

It is good to hear from you. Just this evening there was another Restor post about problems with night driving. I hope your visit goes well with the doctor. I am still in limbo. I go back to MASS Eye and Ear Monday. Their plan was to see if a distance contact over my Restor eye helped correct my vision and even out my eyes. If the answer was yes then they felt I should try the Yag and Lasix to correct the far sightedness caused by the improper prescription. I am getting to the point where I am wondering if I should do this and live with whatever improovement I get and be sooo thankful I never listed to my first surgeon and "took a leap of faith" and did a piggy back lens over the restor and a second restor!!!  What I found is that yes the two eyes worked better together but that when my vision was checked by my local doc following up with my corneal ulcer (from contact lens) it still was not great in my restor eye.(varies between 20/40 to 20/80) I never feel that I can rely on that eye alone as I do my non restor eye at night with my glasses (with restor eye blurred out with frosted glass). So frustrating I traded problems seeing at night to having to plan my day around how long I can keep a contact in. It has prevented me from going to many evening meetings and activities.
I agree it is good to have a place to vent because I believe my family and friends are sympathetic but are probably tired of hearing about something that they are powerless to help with.
Let us know how your visit goes and what the doc recommends. At least we can persuade others not to be so quick to jump to these IOL's.
londonbridge

[aleif]

I went for another opinion yesterday with a new surgeon of national reputation. He is the second ophthalmologist my husband and I have seen who stated he had recently attended a conference and strongly implied he would be limiting his use of multifocal IOLs and moving to “more established, traditional lenses.” (Three total altogether with this opinion.)
I felt much better with him personally and wished I had gone to him first. He confirmed that the ReStor lens was properly placed and the YAG properly done. The power of the lens is off, but no explant of any kind is possible because the YAG “sealed the deal.” He said “he would not perform such a risky surgery himself, as among other things he feared the vitreous would [push thorough]…” He said LASIK would improve my vision and referred me to his partner, who had done my Lasik in 2000. The left eye cataract is getting worse. He said that ReStor are made to work together, “his patients hate him the first eye, but feel better the second”  but with my result, he would not feel comfortable using another ReStor. We need to resolve things with the ReStor eye first—and expensive of course.
Overall, he emphasized many small things working together to make my vision not work. I have had this problem before and reached resolution (sometimes after several docs) He thought that the failure of the lens stemmed from a combination of factors: drying of the eyes due to surgery/lenses “causes fluctuating changes in refraction even if you do not feel that your eyes are dry”. He recommended  more aggressive dry eye treatment. Also retina problems as he viewed small [… things] he felt should be checked. I hope he is just covering himself and being extra careful, as I will be using him for the other eye, which is coming faster than I had hoped. He seemed confident that he could solve my problems and have a good result.
I tried driving at night last night—well, we needed some Xmas tree lights LOL. Kids. OK, it was all right for non-freeway. The dominant right ReStor eye is getting stronger for far away. Near not so much. Night activities are very limited now, because there is so much traffic here—all those oncoming headlights. In retrospect, I should never have left my comfort zone (docs I know. I have to remind the first one that it is his obligation to inform me and tell the truth. This is a tricky area as doctors have broad range in deciding what to reveal to patients and how) I did not realize that this process would be so interactive.  Again, thank you all for your kind input—it has really helped me to understand the process and come to terms with next steps.    
PS Please do not do the YAG unless you have the classic symptoms--steady immediate loss of vision + 2nd opinion+ love your ReStor!                                  

[aleif]

Can you please send link to adverse reports FDA? Can't seem to get there...Thanks, Aleif

[londonbridge]

The link for the adverse reports for the FDA is: www.fda.gov.medwatch, I believe. I sent them a report and also reported my problem to the Alcon Corportation, makers of Restor.
Good luck. I do think as many people as possible should report problems they are having so that the company and FDA are aware of these issues.

[Lerbea]

www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm

This might not automatically get you there by clicking on it.  If you have to type in the name be sure to put the www. in front of it.  Once in it just put in the Mfg. name and the brand   and widen the dates fron 2000 to 2008.  .

[John C Hagan III, MD, FACS, FAAO]

I was asked to comment you your discussion. I will tell you right off I have not read the entire discussion thread. I will make some comments.

1. Ask yourselves: If I was told BEFORE SURGERY that I might need glasses some or most of the time even with a ReStoR IOL and I was told that my night vision would be bad and that optical abberations might be a big problem (dysphotopsia) would I have had the surgery ?   If the answer is yes then you knew what to expect, if the answer is no you were not informed (or forgot that you were informed). Remember many studies show that patients remember very little of what they were told about complications, side effects or dangers of surgery. This has been proven with taping informed consent at the Mayo Clinic then asking patients a week after surgery to mark on a chart what they had been told).

2. At present my opinion is that everyone should know what's noted above in #1.  Many people remember being told this and accept it as the price of less glasses dependence.

3. I think it unlikely that you will get the ReStoR removed from the market. The ReStor works well for many surgeons and many patients. Not so good for patients with small pupils.

4. I'm starting a study here on MedHelp.com Eye Forums on ReStoR, ReZoom and Crystalens.  In doing so I spoke with the editor of a medical journal. I told him from my prespective there were more complaints about ReZoom IOLs than ReStor and Crystalens. The Editor said that he heard more complaints about ReStor than ReZoom.

5. It certainly doesn't hurt to post all your problems and complaints with the FDA. I think what will happen is that better and better accommodating IOLs will come out over the next 5 years like the new Crystalens HD and ReZoom and ReStor will increasingly be viewed by the public and surgeons alike as antiquated technology.

6. I realize that doesn't help people with ReStors in their eye now that are having problems.  For severe problmes ReStor removal with insertion of a aspheric hi quality monofcal IOL and use of glasses will take care of the problem.

That's about it.  Would I put a ReStor, ReZoom or Crystalens in my eye if I needed cataract surgery. NO WAY.

7. Is their heavy economic pressure on eye surgeons to have patients "upgrade" to the more expensive "premium" (misnomer) IOL. Absolutely.

JCH MD

[Lerbea]

Here's a little extra comment I have.  When I was considering the type of Lens (multifocal) I was told the possible problems of surgery.  I specifically used the words FDA and Adverse Reports asking if there were any.  The surgeon and her staff told me "No".  I had been thru previous FDA unapproved joint implants in the 1980's so I knew to ask with these words. The joint problems are still haunting me daily.

Being a little compromised with the internet I couldn't find the correct page on the website with all the reports.  Things would have gone differently if only...Now I will try to help inform others.

[aleif]

Thank you for your post. I too, have a "past" experience that had made me want to inform others. Patient activisim, done the right way CAN help others, and CAN change the way things are done. This forum has been a real help to me going thru this. Alief

[aleif]

Thank you for donating your time and your thoughts to clarifying about IOLs.  Yes, antiquated technology is our impression from discussion with doctors.The thread went a bit off course, I am wondering  about the risks of explant, particularly after YAG. We are trying to find our way AFTER only one ReStor. Remove it after YAG? Do LASIK? Be happy we have one natural eye, although filling with a cataract? Are the risks more significant than the benefits? Opinions seem to vary about the risks and I cannot seem to find “the middle ground” on this subject. This long thread is very helpful to patients! Aleif

[John C Hagan III, MD, FACS, FAAO]

"Answers" will vary. For some time will take careof the problem, for others glasses some or all the time will help. For others the IOL will need removed.

JCH MD

[londonbridge]

I agree with Alief, this long thread and the forum has been a lifesaver for me. It is a place to explore the complex realm of seeking good vision.
At this point I have some questions as I am leaning once again toward and explant of the Restor and my surgeon is more willing to do this now.

I am in a similar place to Alief, except I did not have laser vision correction prior to my cataracts and I have not done the Yag.
For the past month my surgeon at MASS Eye and Ear and the associated optometrist had me try contacts over my Restor with the purpose of assessing whether or not I can correct my vision adequately with refraction to give me an approximation of what the Yag and subsequent lasix might accomplish. I tried both a +2.50 for mid distance and a +1.25 astigmatism lens in my Restor eye (which is now moderately farsighted) and a -7.5 in my non Restor dominant eye, without an astigmatism correction. That eye has a small cataract.
After all of this I was able to achieve about 20/40 best correction. While the two eyes seemed to function okay for distance, the Restor eye alone was pretty much the same, maybe a little better having better focus. Ghosting is less than six months ago, the implant was July, but still present. Night glare is bad, but compensated by my non Restor eye.  My surgeon said if done by January he would attempt to remove the restore and place an aspheric monofocal in my Restor eye. We would then wait to decide about the other eye.
Here are my questions.
1. I have read about the "new technology status" technis. My surgeon is considering a toric lens to correct my .75 to .100 astigmatism. (he does not recommend limbic relaxing incision). What is your experience with toric IOL's and does technis have them available in the "new technology lens" ? Would I be better off not doing a toric IOL. My other eye has a similar astigmatism and I don't mind wearing a regular contact in it.
2. I would like to capture some intermediate distance for seeing things on my counter top, etc. (I am almost there but not quite with my -7.5 distance contact) However I don't wont to sacrifice distance. Would blended mono vision give me enough distance and a little better intermediate ( I don't mind reading glasses). ?  If I go straight distance in both eyes  would I will still be unable to get progressive glasses for intermediate and near given that my unoperated eye is very myopic -7.5.
3. Would you do the first eye (non dominate) for far distance instead and leave the intermediate distance until later or change my contact in the dominant eye to an intermediate distance? (I am pretty happy with it for distance now)
4. My surgeon is world renowned but honestly does not do very many explants of restors. He is however conservative and I trust his judgement. Would you seek out someone who has done many of these instead?
Obviously I realize these decisions are mine and my doctors to make. I know I have asked some of these same questions before at different times. It is just that I am becoming more "focused" excuse the pun on my solution.
With regard to the consent issue. It might be helpful for patients to view a video of the effects of these premimun IOL risks, benefits etc and sign off that they have seen this, such as what we did when my children had their wisdom teeth removed. There are so many questions that patients may not know to ask.
Thanks again.
londonbrideg.

[aleif]

Thank you for posting. I have been waiting for your post! They seem like they are trying to help you and are competent to do it. Just let me know if you can get those questions answered, as I have the very same ones and I am too having a hard time getting an exact answer. At least they are giving you some lenses to try out.
As I posted earlier, I changed to another practice group. I have not seen their optometrist yet. They are leaning towards LASIK because the refraction for me is not off by that much (.75) If that fails, they gave the OK for an explant with their explant surgeon. My understanding is that without YAG and other retina/disease problems the explant is not that difficult a surgery when done by an expert.
The new practice divides the process into many different specialists, good but time consuming and requiring great insurance coverage or a trust fund! One is expert on putting in IOLs, one on removing them. I know that sounds odd, but the DC metro area is very large, so they get a concentration of patients from all over.
The initial intake/consent form divides vision into zones 1-5. I think zone 1 is tiny close up thru 5, which is very far. I am finding it difficult to get info on the specifics of what each lens does b/c still trying to solve the ReStor issues. Monofocals: no intermediate vision, or fixed with glasses?  I notice that the consent form (long and detailed) says, “Chose ONLY 1 zone” so it may be that “blended” (choose 2 zones, one per eye?) + glasses/contacts may be the way to go. Technology seems to be best in Zone 5 (far). They admit that IOL technology is flawed, but all we have at present.
I was exploring this with the retina doctor (not his area) but he warned to consider the remaining cataracts development. “Don’t make a decision based on your present vision with the cataract. No one can predict how fast a cataract will grow. Make a decision based on the fact that SOME form of technology will have to be used for the cataract.” The retina center is one sobering place.
Right now, I am leaning towards Lasik the ReStor eye, make a decision then, and a monofocal for the other one. I lived for years with blended vision due to my correction with large difference between the eyes. Lack of intermediate vision is problematic—I knew I had a problem when the grocery clerk followed me around picking things from the shelves for me. Blended vision is odd, but do able.      
I hope this helps and do keep me up to date on how you are doing. Aleif            

[londonbridge]

It was good to hear from you. Thanks for your support. I am feeling more comfortable with the idea of an exchange. My eyes are 9 diopters apart at present and my Restor eye is moderately farsighted verses -8 in non operated eye, so I obviously must do something!
I scheduled my exchange for January 7th and plan to meet prior to that with the surgeon to discuss a new IOL. Presently think I would not do torric, rather have the astigmatism (although the surgery could change that also). Mulling over whether to go for a little near sighted in the Restor eye (non dominant) or straight distance with glasses always for intermediate and near ( I wore glasses for years without much complaint, but somhow being dependent on glasses full time, the opportunity to only use them for reading is appealing, that is what got me into trouble with the premium lenses however and I wonder if I should cut my loses and go for just distance in both eyes.....decisions, decisions. I am quite anxious about the surgeon a. not being able to explant the lens properly and b. ending up with the wrong power again (however a single wrong power has got to be better than the Restor)
Well good luck with your lasix. I think if my IOL wasn't so far off, I would have done the YAG and lasix as well, and still may, but probably going for the exchange.
Take Care
londonbridge

[JodieJ]

Unfortunately, the formulas used for IOL power predictions are much less accurate for people at the tails of the bell curve (i.e., the very nearsighted and very farsighted).  However, your new surgeon will have the benefit of having your ReStor calculations and result, so he could make adjustments to your new calculations as appropriate.  Given your preferences, I'd go for an exchange and good intermediate vision--why not try for what you want?  (You could either have a LASIK touch-up or wear a contact lens if your results with both eyes were much less than perfect.)  BTW, Dr. Hagan has posted elsewhere how he would eliminate mild astigmatism at the time of surgery.  And he recently responded to another post by stating that IOL exchange is not considered "high risk."  

[londonbridge]

Thanks for your suggestions. It is strange that when you must wear glasses all of the time as I did for many years, it seems easier than taking them on and off nearly all the time. Since I will need glasses ( and contact lens in one eye) at least for a while I do prefer limiting when I need them i.e. reading. I suppose this is a process and I could eventually touch up my final results. My biggest concern is ending up far sighted again where nothing is in focus. That is probably unlikely and I am leaning toward trying for my non-dominant eye with intermediate.  

[aleif]

Yesterday I went to the doc who did my LASIK for a consult. This is the only practice that was able to find a refraction I could see in a normal way—the best by far. At other places, they would just look at me when I told them I could not see with the chosen refraction. Ghost images—gone. Double images—gone or reduced.   When the doc rechecked the refraction (done by the tech), he seemed very surprised when I said, the correction was “just fine, not a problem, looks great.” I think there has been astigmatism after the surgery and no refraction used for it. He was confident he could make the ReStor lens work correctly, or certainly much better. That was a BIG relief.
He said, “The ReStor lens is well placed, perfectly healed, but the wrong power.” I asked him about explants. He said, “With your result, it would be insanely medically irresponsible—out of the question.” (He is a bit colorful in his speech) I was all ready to do the Lasik when he rechecked and said, “No Lasik, and PRK better for you.” He was very firm about this and gave medical reasons-- adamant. I trust his judgment here, BUT…He was frank and explicit that PRK is different than Lasik, and particularly in the recovery phase. The recovery phase is long and somewhat painful/sightless/problematic.
When a doc says something is painful, they are usually NOT wrong, in my experience. I am a bit scared. I made an appointment for the PRK, and plan to have my sister come to help me. It  takes courage to face eye surgery—at least for me. Hope everyone is well, and Happy New Year.

[JodieJ]

Good luck with the PRK!  My cousin had that procedure, with excellent results, and she didn't not find her recovery to be terribly long or uncomfortable.  Let us know how things work out.

[peakhope]

That's great to hear that you should be able to get good vision without explanting. My wife is happy with her Restor lens. I wonder how many unhappy Restor users have uncorrected astigmatism and/or an incorrect power.

I am going with IOL + LRI myself, but if I were going to have a laser procedure it would be PRK. The recovery time is longer, but the eventual outcome is at least as good, and it's a bit less structurally intrusive to your eyeball. Plus the idea of scraping away the outer layer of the eye is less icky to me than slicing a flap.

Local eye docs here claim the all-laser lasik has its own problems, and that many docs who were using it are reverting back to the blade. Don't know if it's true, but I heard it from two unrelated offices.

[Lerbea]

Wearing a trial pair of glasses with corrected lens will give you some idea of what Prk and Laser will do for you.  Search the archives for other patient results with the additional procedures.  I tried the eyeglass lens correction and it did nothing for my vision.

[londonbridge]

I am glad alief that you found an answer and a way to correct your Restor Problem. It does sound like if you can get a refraction that will correct your problems it will simulate what the PRK will do for you. I wish you the best.

As for me, I had my Restor lens explanted yesterday at MASS Eye and Ear. All went very well with no problems. The surgery was tricky but I was in good hands. I worked with my surgeons and trusted his advice. I now have an Acrysof Toric monofocal in my left (former Restor Eye) that will be corrected to approximately -.75 to -.1.25 for mid distance when the final results are in. Today my stitch was removed and I had 20/40 vision for distance and that was less than 24 hours with still some higher pressure, swelling and dilation so I expect to see more improovement. Even if there is no more improvement the halos, glare, ghosting, double vision are gone. Furthermore my eyes are no longer 9 diopters apart with one moderately far sighted (wrong power Restor) and my natural eye a -8.0 near sighted. I feel like my eyes are working together again not fighting eachother. I plan to continue with a contact in my dominant, natural eye for distance and use reading glasses over top when needed. I find I can even get around the house with only my IOL eye corrected and since my natural eye focuses about six inches from my face, I may even be able to read without my contact in, but we will see.
I am grateful for all the support I have received from all of you my forum friends as well as the advice from the doctors. I don't believe I would have survived this ordeal without you and I plan to keep watching the forum.

[Lerbea]

Glad to hear another Restor IOL exchange story with good ending. I too had this done with the exchange in Nov. .  2 weeks ago I got my glasses to further compensate and my vision in the surgery dominate eye with glasses and the new IOL exchange AMO aspheric lens is almost perfect.  I am so grateful for this miracle after the nightmare.

[londonbridge]

Thanks. It is sooo good to be on the other side of this "nightmare"  I could not have gone through with this without the support of folks like yourself , JodieJ, Dr. Hagan, Aleif and all of the others. My eye is still healing and vision is still a little blurry but a definate improovement. Already better sharpness than the Restor with a contact over it. I am already dreaming about a new pair of glasses. I plan to continue to wear my distance contact in my right, dominant, natural eye with the minor cataract and get glasses to sharpen up reading etc. My hope is that I can also use those glasses or another pair for when I am unable to wear my contact also. Anyway no more double images, ghost images, no focus at any distance, and two eyes that were fighting each other.
Glad to hear things are looking up for you too.
londonbridge

[JohnO123]

londonbridge – since I am having the same procedure at the same hospital by the same doctor, can you tell me what it was like? How long did it take? Was it painful? Did they treat you well? I wouldn’t object if you didn’t spare any details ………..LOL

[Lerbea]

My IOL exchange went quick less than 30 minutes I think.  I was awake, the eye was numbed by injection and I didn't even know it as they gave sedative just before. Told me I wouldn't be able to move the eye or see because of the way it was numbed. Right before the surgery I told them they better check that as I thought I was moving the eye  but wasn't. That was funny.  It wasn't really painful the next day but a little uncomfortable so I took pain meds just to be sure that first day.  I was real apprehensive the few weeks till I got the glasses but everything was cleared up with the glasses.  Right after the surgery I knew the ghosting was gone along with the glistening.

E verything was so professional and of great care for me as a patient. Emory billed the insurance correctly and was paid promptly by the insurance co. I highly recommend Emory University Hospital.

It wasn't like with the individual doctors which really tried to pull a fast one with billing and charging me. But I caught them and won out.

[JohnO123]

Lerbea -- Thanks so much for the input. It helps a lot. Many, many thanks........I'm glad you're doing well.

[londonbridge]

Hello  John0123
I was very pleased with MEEI and Dr. Melki. There was an intial delay in my surgery from 7:30 arrival time to 9:30. I think they were back logged because of the snow. Fortunately we stayed over night at the John Jeffries House owned by the hospital so we could be there on time, but I believe you said you already lived in the Boston Area.
One thing you may wish to be aware of, although it could be different for you, is that I did not receives any sedatives before going in to surgery and the preference was to use topical numbing drops verses an anesthesia local block and no IV sedation. In otherwords they preferred you to be awake and alert so you could follow instructions. They do imobilize your eye. I felt some pressure and tugging no pain. I think it took about 40 minutes. I was not prepared for this. It was a little unerving, even though I have had 9 other surgeries and am a very calm person able to detach myself from these situations quite well. Still I was anxious because I waited a long time and it was such a difficult decision. My blood pressure went a little high so the anesthesiologist asked to give me very light IV sedation to take the edge off during the procedure. That helped some but I was very aware. I believe if I had know that prior I would have been more prepared and thus more relaxed. The plus side is that I was not groggy or ill after the surgery only craving my morning coffee!!
Right after surgery my vision in my new eye was pretty blurry. The next day at the post op done by Dr. Melki's assistant, Dr. Patel my vision was 20/40 so I could pass a drivers test. ( I also requested my vision be set for mid distance and Dr. Melki recommended a -.75 target which I think was a good choice being that myopic people often can wind up a little more nearsighted so I don't expect far distance to be as crisp) Three days out and my vision is definately improoving but still a little blurry and variable. Last night I noticed some ghosting around street lights but with my contact in my right eye the two eyes worked very well together. I expect more improovement over the next few weeks. I have no pain or discomfort (unlike my Restor surgery where I had a huge corneal abrasion in the middle of my eye requiring a bandage contact, I guess the whole thing was a mess from the beginning!) I have no more ghosting around letters and no more reflections of those darned Restor rings on everything. I am no longer moderately farsighted in my operated eye and the two images going to my brain are much closer together and in harmony.
Overall I am pleased and feel the hospital and surgery staff are first rate. You are in good hands. Feel free to ask me anything you like about my experience. I am glad to help.
londonbridge

[JohnO123]

londonbridge – Thank you so much for sharing your experience. It sounds almost exactly like mine in October when Dr. Melki put in the Toric in my right eye. I stupidly went elsewhere (Scooby Doo Eye Care) for the left eye and had ReZoom with the promise of no glasses anymore. They put the wrong strength in besides ReZoom being a poor choice to begin with and now I am left with hideous blurriness and night misery. So now I have gone back to MEEI kind of hat in hand asking them to take this piece of garbage lens out and put in another Toric. I’ll have to wear glasses to read, but so what? The things I like most in life – running, golf, hiking, concerts – won’t need glasses. I am really beating myself up for not going to MEEI but there’s no looking back, as they say…….

In October, I was scheduled for 7:30 surgery and didn’t get on the table until noon. That was a little unsettling being left to sit all that time with no explanation but the medical side was awesome and the time on the table was about what you explained. I have only had this beastly implant in my eye since December 30, so I am reading that being such a  short time should be less tricky. Yours was longer, right? What do you think on that? I just want this thing out and am miserable waiting until February 2. I guess he’s only at MEEI the first Monday and Wednesday of the month for surgery.

[londonbridge]

Glad you are able to go back to MEEI and Dr. Melki. Having the Rezoom in such a short time should be a definate advantage. My surgery took a little longer but fortunately my Restor was not as stuck in the capsule as we thought and the capsule was not stuck to itself. Dr. M is only there a few days per month for surgery I believe because he has a busy private practice in Brookline plus teaches at Harvard Medical School. He is a wonderful, skilled and caring surgeon in my opinion. Very lucky to have found him.
I agree with you regarding only needing glasses to read. With my unoperated eye having a distance contact and my new toric four days out I can already see the computer, though readers help sharpen and I could actually wash dishes without needing the readers. So sad that so many people including me are so wowed by the claims of these lenses. After 40 years of glasses it all seems so tempting, but soo not worth it for me.
Live and learn I guess.
Take heart that your ordeal will soon be over. I wish I had not waited a full six months before making the final decision to explant, but I am so happy that I took the risk and did it.
londonbridge

[JohnO123]

Hey londonbridge – I thought you’d get a kick out of this. I was at MEEI yesterday for pre-op stuff and they were telling me that they do not do exchanges much but had a woman last week that they did and it went so well and she is really satisfied. I wanted to say “yea, I know all about that” but didn’t. Dr. Melki said my ReZoom piece of garbage (my words, not his) is situated in such a way that the removal would be tricky. He laid out the risks and I almost spilled my cookies but when I asked him if he thought it being more than 50/50 chance of it being successful he quickly said “oh yea”. I guess they have to lay out the risks so if it does go bad, they can’t say I wasn’t told and come after them. I understand that but I have to sweat this out until February 2.

Anyway, I thought you’d get a kick to know they were talking about your case (it had to have been you) so positively.

[londonbridge]

Thanks for the update and for not saying anything too. I think it is good that they don't automatically say they can explant anything with no problem. I have talked to other practices who were willing to try anything and I did not choose those practices. I prefer someone to be conservative. Ironically I was also there yesterday at 1:00 for my second post op. I again expressed how sastisfied I was to them. I still have some blurriness due to the medications and some high eye pressure so I have a new medication. I trust Dr. Melki absolutely and I know he would be completely upfront about the risks and benefits. So it sounds good. I will keep you in my thoughts.
My vision seems to be coming in right on the money. I wanted mid distance in my nondominate, former Restor eye and leave my dominant eye for distance, with a contact for now and if needed down the road another monofocal. The blended vision gives me a nice range without glasses so I am happy with my decision. Their measurements and choice of the torric Acrysof lens for me seems to be just right. Once you have a surgeon and a practice you trust it I think it is best to express your preferences and then let them do the choosing.

My best wishes to you. Keep me posted.
londonbridge

[Gina00]

I am looking for some advice from someone who has had their multifocal lenses replaced. I have a Restore in my left eye and Rezoom in right. I now have astigmatisms in both eyes I didn't have before and my left is 20/100. I feel like I'm blind, I can't work (I'm an RN) or drive. The sugeon says it's these "finicky lenses", I would like him to try to do his job with this eyesight he's left me with! How did you end up with deciding what to do?

[JodieJ]

I'm sorry to read about your poor results.  In your place, I'd waste no time getting additional opinions from the best cataract/refractive surgeons in town, especially those who are very experienced with multifocal IOLs.  You might try calling the ophthalmology department at a major medical center and requesting an appointment with their senior staff member who specializes in cataract surgery.  If you're considering explanting your IOLs, don't agree to a yag procedure--it will make the explant more difficult and risky.

[peakhope]

I'm not a doctor, so you should definitely discuss options with yours, and probably get a second or third opinion as well.

You didn't really describe your symptoms. If your only problem is astigmatism, I would think that you should be able to wear glasses to correct it. If that works, you could get LRI's. They are a quick and relatively painless, low-risk procedure. Or you could wait a few months and get a PRK. Astigmatism could be causing or enhancing other visual effects with your lenses.

Definitely don't let yourself get pushed into a yag. And you should quickly but carefully evaluate all of your options before going with the relatively drastic explantation to switch to another lens. It may or may not be your best choice.

[Lerbea]

To Gina00
I had the dominate eye Restor lens replaced with the AMO astigmatic lens.  Immediately I could tell the ghosting was gone.  I still had misalignment of some images i'd guess to say but with the new glasses it is all cleared up in the new surgery eye.  My left eye still has the Restor in it.  I'm waiting to see if the dominate eye will compensate for this.  

Night driving is out of the question for me. The lights are so bright and I can't judge distance.  Still it's the restor that's giving me problems.  
If I think I can live without having to drive much at night I won't have the other lens replaced.  
I was scared for a few weeks after the replacement exchange but glasses cleared it right up.
If I'd known about the Adverse Reports with the FDA I would not have had the Multifocal used for my eyes.  My old doctor and staff told me there were none.  HA.

My vision in the dominate eye with glasses is almost perfect.

[londonbridge]

Glad to see you found the thread I started about Restor.
I posted a comment in the expert forum as well.
Like Lerbea, I did notice that the ghosting, double images, contrast sensitivity and large halos and glare were gone once I got rid of the Restor. The quality of vision is much improoved and feels more natural. I am planning to correct any remaining vision with glasses. Since I did not do my dominant eye at all, I need to continue to wear a contact lens in that eye, because I can no longer wear glasses without a contact lens due to the big difference in my two eyes, my original eye still very myopic, -8.0 and my new eye slightly near sighted (my choice).
Good luck. Consider all less invasive procedures carefully. Weigh the possible benefits and whether these will be sufficient to give you the quality and quantity of vision you need and deserve. Be aware of the risks of explanting and find a surgeon who will give you an honset evaluation of whether this is a reasonable option along with any risks. Good luck!

[aleif]

Londonbridge and Lerbea, I am so glad you had good results!
I am trying to use glasses to see what vision would be like if the ReStor worked correctly. I have glasses for far that vision work pretty well. The image is a bit too sharp, and now that both eyes are working together, I really notice the highlight problem—on ALL light sources, including rings in very dim light, and the light of white paper around type. In bright light, they work all right but in dim light, they are a problem. There is still a strong dependence on the cataract eye, which is progressing steadily, unfortunately.
On order are glasses for reading—the ReStor has never worked well for that, but maybe with a new, stronger prescription they will work better. I have drugstore readers but I am trying to make both work together, which means different corrections for each eye. My doctor recommends COMPLETE satisfaction before going forward with the PRK. He is conservative, which is good.
I am torn…I cant help but feel that I am going thru a lot of expensive invasive surgery to make a product that doesn’t work well, work a little better. If this were a car or a dishwasher, I would have protection by the “lemon law”—this way, we put our eyes and pocketbooks on the line to correct design flaws. It is not a good feeling. Sorry, I am a bit discouraged today. It is good to hear that others are solving the problem—that always gives hope. Aleif

[JodieJ]

Your feelings make complete sense to me.  What is your doctor suggesting in the event that you don't attain complete satisfaction with your ReStor vision?

[londonbridge]

I have been wondering how you are doing. It sounds though that you have found a doctor who is logical and methodical in helping you explore and weigh all of your options. That is important and why I ultimately went with MEEI. They did not have only one answer but let me evaluate all of the possibilities.
Believe me I understand and feel your frustrations. I think no option is perfect and one has to weigh the risks and benefits obviously. I am happy with my choice, but I still do not have a perfect situation. My new eye works great at one focal point, (about 14"- 3')which I am most grateful for. There is still some blurriness (could be the capsule, but not significant enough to warrant doing anything). I still need a contact in my dominant eye and I plan to get glasses over top to hopefully sharpen up reading for both and distance for the IOL eye.  So I guess what I am saying is that even if you decide to live with the Restor eye, do not regret making that choice either.
Best wishes and keep us posted.
londonbridge

[Daktariloo]

Dear Dr. Hagen, You said:
"Ask yourselves: If I was told BEFORE SURGERY that I might need glasses some or most of the time even with a ReStoR IOL and I was told that my night vision would be bad and that optical abberations might be a big problem (dysphotopsia) would I have had the surgery ?"

I just stumbled upon this website yesterday! I would not have selected ReStoR implants for my eyes if I had been told this by my ophthalmologist. Because I had nearly mature cataracts, I would have gone ahead with cataract removal but selected single focus implants for both eyes. I am a retired M.D. (family practitioner) who , 5 years ago, switched from my previous ophthalmologist to my current one after reading a newspaper article (it may have been an advertisement) that the latter's clinic was inserting multifocal implants that often eliminated a patient's need to wear reading glasses after cataract surgery. Before the surgery I do not recall my surgeon's mentioning of the likelihood of bad night vision problems and dysphotopsia postoperatively. He did mention that some patients saw halos but that these usually were transient side effects. His staff provided me with literature that discussed the side effects of ReStoR implants. The literature did mention that some patients experienced halos and discussed the usual major side effects such as eye infection and retinal detachment. In retriospect, as a physician I should have done more research on the ReStoR implants before slecting them for my own eyes.Right after surgery I noticed large halos and long radial rays/light streaks emanating from the light sources. My ophthalmologist assured me that these side effects would lessen with time as my brain adjusted to them. He has told me this several times on followup visits. With time my mind apparently converted what used to be halos to large circular ghost images (having a radius of about 4 to 5 times the diameter of the light source, for example) Now, after 5 years there has not been any significant reduction (at most, 5 to10%) in the ghost images and long radial rays. I feel that the overall result of my cataract surgery has been a loss of at least a third of my visual acuity at night. I've continued to drive some nights but have almost collided 2 or 3 times with other oncoming vehicles. For me, the worst driving conditions may occur at dusk when most vehicles have their headlights on but some have not turned them on. On an out-of-state trip 2 months ago, for example, while driving on an unfamiliar highway, I made a left turn at an intersection after carefully looking several times (as I always do) to ascertain that no vehicles were approaching. A little into the turn my right seat passenger yelled out a warning. I hit the brakes and stopped in time. I think that the light streaks and ghosts from other vehicles may have partially obliterated my view of that oncoming one.
Following this recent close call I decided to return for another consultation with my surgeon. Last week he did an extensive exam, refracted my eyes and ran several tests, which included a retinal scan. He assured me that everything looked fine (from the outside looking inward, that is! - not from the inside looking out which is what matters most to me). He told me that there was not much that he could do to correct my nighttime impairment. He also stated that removal of the ReStoR implants might result in considerable permanent damage to my vision because the implants were cemented into my eyes. By this I understood that they were cemented to the insides of the capsules. My daytime vision also is not all that acute. With eyeglasses my distant vision is 20/40. I do not see well at any distance and must wear separate eyeglasses and other glasses for reading and working at the computer.

Although I presently am 76, I am in relatively good health and anticipate that I may have 18 to 20 years more of life (My parents died in their mid 90s and their parents lived just as long if not longer than them. I have no chronic illnesses at present and have neither smoked nor consumed alcohol or other harmful drugs. After confessing to my wife of my nocturnal impirment, she insisted on being my chauffeur at night. I've also given up flying airplanes. This was due to being afraid that I would not be able to spot other airplanes while in flight. Night landings also might be extremely hazardous for me.

Reading this long thread about explanting ReStoR implants has given me some hope that my vision may be restored to a near normal state - instead of having to live with my visual impairment for another 20 years. I live in California, several thousand miles away from the experts in Massachusetts and Connecticut who were described to have successfully removed some ReStoR implants. I am, however, 3 or 4 hours drive away from Stanford University, UCLA and Univ. of California, Davis. Might I be able to find ophthalmologists at one of these institutions with the expertise to successfully remove my current implants and replace them with single focus ones? I know that I should be able to pose this question to my ophthalmologist during a subsequent visit. In the meantime, however, I am going to be trying his suggestion of wearing polarizing lenses with two-surface anti glare coatings. I am going to comply even though I had to suppress myself from stating that I really need the polarizing, anti glare lenses between my fresnel implants and my retinas. Thanks for any comments or suggestions you might have.
Larry L, M.D.

[cataractSATX]

I a male age 46 and was diagnosed with a cataract in my right eye at age 42. My vision was better than 20/20 in my left eye at age 42 (20/17). My right eye was 20/20 at age 38 before the cataract and 20/200 at age 42.

My problem is this. I have a terrible phobia of having my eyes "probed". Some conditional things. I take Synthroid and Allopurinol. I have very pale blue eyes and have always been very sensitive to sunlight.

Is it possible to take anti-anxiety drugs like Halcyon before these procedures?

Given the good state of vision prior to cataract is there a predisposition to a negative outcome with a Multifocal lens?

Any known drug interactions with the above listed drugs?

Thanks in advance for any help.

[tc490]

RESTOR HAS BEEN THE WORSE MISTAKE I HAVE EVER MADE. I WOULD ADVISE ONLY A PERSON THAT IS DECLARED LEGALLY BLIND TO ATTEMPT IT. I AM SCARED TO DEATH THAT MY EYE'S ARE PERMANENTLY RUINED. I HAD A RENOWNED EYE SPECIALIST THAT HAS PERFORMED THE PROCEDURE FOR 10 YEARS IN CHARLOTTE NC TO PREFORM THE RESTOR PROCEDURE ON MY EYE'S. I HAD IT DONE OCT.13, 2012 - YAG NOV. 7 I HAVE SEEN NO IMPROVEMENT AT ALL ! I SAW  20/20/ DISTANCE VERY CRISP AND CLEAR IN BOTH EYE'S BEFORE THE PROCEDURE AND 20/100 - 20/150 IN CLOSE UP IS WHY I HAD THE PROCEDURE GOT TIRED OF READERS, BROKEN ARMS ON GLASSES, SMUG ON GLASSES, COULDN'T KEEP UP WITH THEM.  MY EYE'S ACHE, WATER, AND I WISH I COULD GO TO BED AND NEVER WAKE UP. I AM A POSITIVE PERSON AND LOOKING TO WAKE UP AND SEE IMPROVEMENTS AND THERE ARE NONE. I CAN SEE WITHOUT READERS BUT IT IS FRUSTRATING WHEN YOU LOOK AT THE WORDS YOU HAVE TO FOCUS LIKE A LENSE ON A CAMERA.. THEY PUT TUBES DOWN MY TEAR DUCTS AND THEY ARE UNCOMFORTABLE.I WOULD DO ANYTHING TO HAVE MY EYE'S BACK THE WAY THEY WERE BEFORE THE PROCEDURE!      

[tallady2]

I too am very unhappy with my RESTOR lense. The doctor now wants to do the YAG surgery, but, I am very concerned that this will not bring any relief. And I am very concerned about having the RESTOR lens removed and  having a mono-focal inserted instead.

[tc490]

ARE YOU SAYING ONCE YOU HAVE THE YAG YOU CAN NOT HAVE ANY OTHER PROCEDURE? CAN YOU TELL ME ABOUT THE PROCEDURE YOU ARE TALKING ABOUT HAVING AND HAVING RESTOR LENSE REMOVED?

[ladymail08]

Gina, i do medical records and coding for a hosptial and i was duped into getting the Restor lens and i was BLIND like you afterwards.  It was a disaster and nightmare.  prior to that "lasic consult" I wore monovision contacts with great succes. was just getting tired of the gas perm contacts and wondered about lasic correction  INSTEAD  the schisters told me i had cataracts and the RESTOR lens would make me see near and far perfectly.   After one job loss and 4 months of the place telling me to be patinet, I went to a specialists in Indianapolis in, price vision group and they explanted the restor and with great success put in monovision lens and restored my sight..... I wish you the best - i understand your difficulty... i urge you to get them explanted before they scar into your eye,  mine were nearly too late.   nyoka
i dont know where you live but Dr Price is the best in Indiana

[ladymail08]

Dr Price in Indianapolis Indiana was awesome for explanting my Restor lens (which had me blind)
He corrected my vision that the other screwballs destroyed

[ladymail08]

i still recommend Dr. Price in Indianapolis Indiana - he successfuly explanted my restor lens and restored my vision with monovision lens implants.  He is a world renouned eye surgeon.  

[CherylLee76]

What type of lens was put in your eye after removal of the RESTOR? Is ReStor a mulitfocal lens? I have a cataract in left eye and I thinking the ArcySof monofocal with blue blocking light. Arcy IQ?

Thanks for any information you can give.

[CherylLee76]

Also what is your vision now? 20/20 ? Do you need readers and how is your intermediate distance/long distance. thanks again.