Near Vision after First ReStor IOL implantation

[Gichuki]

Pre-cataract surgery I was near-sighted w/ mild astigmatism & steep corneas. Wore glasses for 45 yrs/alot of PC use/close work hobbies.
1 mo. post-dominant eye surgery I drive w/o glasses;can see PowerPoints in lectures;mo longer wear glasses. Night driving vision improved-fewer halos than before.
  Altho I'm pleased w/this distant vision, I am distressed my "second sight" cataract-caused vision in my eye w/cataract is superior to my near vision in my newly implanted ReStor eye. Yes my "second sight" will deteriorate/I will have to implant some lens in my 2nd eye. I am assured w/the 2nd ReStor implant my near vision will be better & my vision won't improve until I do get the second implant. It doesn't make sense that if I can't see up close now that I would see so much better up close w/ a 2nd ReStor implant. I can't "trust" my near vision will improve w/ 2nd ReStor. I wish no more surgery to get near vision back & I don't want to start wearing readers for up-close reading when I've not had to wear glasses for the last 2-3 yrs. I understood the ReStor's strength was near vision.
  I have difficulty reading my piano music through the blur; can't read blurry book page 8-10 inches from my eyes w/o aid of my original lens w/cataract. Using only the ReStor implanted eye,computer text is blurry.I have traded near-sightedness for far-sightedness. Thx for any insights to my near vision concerns.

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

Intra-ocular implants (IOLs) that are multi-focal (can see distance and near and are so called 'premium IOLs', take longer to adjust to than regular single focus IOLs. One month is not your final result and most patients improve over subsequent months. Some patients that are ultimately very happy with their multi-focal IOLs take 6 months to fully adjust.  Also even with premium multi-focal IOLs surgeons cannot guarentee that patients will not need glasses for certain tasks (night driving, sporting events, computers, sewing, etc) to achieve the best possible vision.

Also with muti-focal IOLs 'rivalry' between the eye with the IOL and the eye still having a cataract is often more troublesome than in mono-focal IOLs. Your brain is being presented with two different images from each eye that differ in clarity, focus, color persception and with different glare disability and contrast sensitivity. This situation is not unlike having two different people talking to you at the same time. In this situation vision may seem better by closing one or the other eye.

Rivalry is often helped dramatically by surgery on the second eye. Also when the second eye is done your surgeon can 'tweak' the power of the multi-focal IOL to compliment the first eye for various tasks/distances.

In any case there's no reason to rush into a second procedure until you are satisfied with the results of the first procedure (provide your expectations are reasonable--a multifocal IOL is still nothing like a 16 year old eye with youthful focusing power).

Surgeons that use multi-focal IOLs have a wealth of experiences about the recovery period of their favorite IOLs. As such your best souce of information is your EyeMD (eye surgeon).

JCH MD

[JohnHaganMD]

Multi-focal intraocular implants (IOLs) or Premium implants are not for everyone. The ideal candidate is a "glasses hater". This is the type of person that would do literally anything to not have to wear glasses. Most often this type of person doesn't like their appearance with glasses on or does not like the feel of glasses on their face. Other reasons include never having worn glasses or poor adjustment to bifocal or trifocal or no-line progressive bifocals.

Multi-focal IOLs have disadvantages as this discussion thread points out. They are more expensive, require a higher level of surgical complexity, have a higher complication rate, have higher rates of IOL removal/exchange, reduced night vision, higher rates of IOL light glare/flare/halos/steaking.  Nevertheless, their use is increasing indicating that over-all the results in properly chosen patients can be good to excellent.

Forums such as ours give a skewed picture of many problems as people that are totally satisfied with their multifocal IOLs (or who have had good results with surgery/treatments) are not out trolling the internet trying to find solutions for their problems with multifocal IOLs.

If I were having cataract surgery next week I would not have a multi-focal IOL inserted in my eye. I have worn glasses for 30 years, I don't mind them at all. I want the least complicated IOL procedure with the highest success rate and the best quality vision and excellent night vision. Since I'm near sighted and have been able to read without glasses at near I would ask the surgeon to leave me nearsighted so that my best vision without glasses would be at near/reading distance. I would continue to wear no-line bifocals as as I now do. Most people would choose to have their best uncorrected vision at distance knowing they would certainly need glasses for reading.

The accuracy of picking an IOL power is not an exact science but has improved to the point where over half of patients with single focus IOLs can pass the state driver license without wearing glasses. Almost all of these will need glasses for reading or computer or shopping.

Additionally many surgical ophthalmologists can offer refractive corneal surgery at the time of a cataract/IOL surgery to correct astigmatism. This further improves the vision without glasses.  Select patients may choose mono-vision single focus IOLs where one implants is set for distance and the other for near. Mono-vision is not for everyone and that options should be looked at carefully. It works best in people that have used contacts lens for years that gave them mono-vison.

Remember the old saying "Different strokes for different folds". There is no "right" answer for which IOL is best. Together the patient and the ophthalmic surgeon should mutually arrive at the "best" for each individual patient.

Hope this has helped the folks in this forum.

JCH MD

[DG59]

A related discussion, Why can't I see after Restor? was started.

[Dabsey]

I agree that these forums must be frequented by unsatisfied patients looking for a second opinion. I have just had bilateral cataract surgery with restore iol. Each time I open my eyes I am amazed and mine are still very new with my left eye only 7 weeks old and my right eye only three weeks old so I am looking forward to the improvement up ahead for me. I went into this fully knowing I had trade offs and didn't have overly high expectations which I think is important so that now I am completely blown away by the outcome. I am 49 and have worn reading glasses since I was 40. I hated glasses as they seemed to be either smudgy or fogged or never where I wanted them. I was not a good candidate for LASIK. I was diagnosed with narrow angle glaucoma and had an iridotomy but then found to have plataeu iris. My cataracts were not all that bad but the thickening lens made having them removed benificial for both problems. I also had astigmatism in my left eye as well. I can now read a sms in the middle of the night without having to look for glasses. I can read quite small print in very good light and don't seem to have a problem with distance at all although I have to sit closer to the computer screen and also hold my book a little closer than normal. I have halo but don't consider it all that bad. I must add that my left eye has a cloudy capsule and I am impatient to have this fixed but have to wait another 6 weeks. I am happy now at this early stage so that when I have both eyes seeing clearly it will be even better as my eyes heal and adjust. My surgeon also greatly my astigmatism so that its almost non existant while he was at it. As my focus gets better each day I am quite sure I won't need glasses unless I was trying to thread a needle maybe or something very intricate but for day to day use I am amazed at the outcome.

[JodieJ]

You're saying that you are very nearsighted, have difficulty tolerating contact lenses, and will be needing cataract surgery soon in one eye only.  I don't think that ReZoom (or ReStor) would meet your needs.  There have been posts from other women with dry eyes who experienced a lot of post-surgery pain after receiving multifocal implants.  In addition, if you want to significantly reduce/eliminate your nearsightedness with cataract surgery and cannot tolerate a contact lens in your unoperated eye, you will be in a difficult situation.  Why don't you re-submit your post as a new question.  Maybe the forum M.D. will have some suggestions for you.

[K-D]

Thanks Jodie,

It is always so hard to read about someone with a problem with a multifocal, because the misery can be great. And it seems the surgeons can get so many unexpected results. And many it seems, are at a loss at how to correct the problem.  It would help if more info was given to patients choosing the multifocal, so that they are aware of the possible problems when choosing to go that route.  

[JodieJ]

Your idea is good, but I doubt that it would boost sales of multifocals, which are reported to be on the decline.  Currently, the "new and improved" Crystalens is said to be the new rising star.

[JeanZ]

I'm brandnew to this site and finding this information extremely helpful.  I'm also in the process of deciding which lense to have implanted during cataract surgery.  I thought ReZoom was the perfect lense, but now I'm totally unconvinced after reading others' comments.  I'm sure glad to read these comments, rather than just hearing the eye doctors singing the praises of ReZoom.  I'm 60, very nearsighted, dry eyes, and cataract ready for surgery in one eye only.  I don't think a contact lense in the other (dominant) eye will work because I haven't tolerated the punctal plugs very well and, as a matter of fact, am going to have them taken out after one week due to scratchiness and itchiness.  Actually, now I'm afraid of any lense at all because of what I read about ghosting and halos.....ay yi yi.  WHAT TO DO???????

[K-D]

In my opinion, with the multifocal so new, many problems with multifocal lenses are not always apparent to the surgeons.

I had a Rezoom lense implanted 15 months ago.  It was 14 months of misery, because I could only see to arms length when inside a building.  I was told that my problem was because Rezoom was pupil dependent.
So, for months and months I went back and forth regarding an explant.  Then I developed the secondary cataract with the capsular bag and needed a YAG.  But I knew that if I received the YAG, I would be stuck with the Rezoom, because after YAG, it is hard to measure the eye for the correct lens implant.  So, after 14 months of misery, I decided, since due to the secondary cataract, and I had hardly any vision, and was too apprehensive about an explant, I went with the YAG.  I expected to live the rest of my live with the inside blurry misery, due to the Rezoom being pupil dependent.  However, I am still in awe.  It was not the Rezoom.  Since the YAG, for the first time since I had the Rezoom implanted 15 months ago, I can see inside as well as outside, and read without glasses.  I sought out another physician and a very simple procedure completely changed my vision.  Now the once hated Rezoom is very precious to me.  I still have halos, but with my clear vision, it is a small problem to me.  And I still have floaters which I am hoping will one day cease.  But the point is, a second opinion is so very, very, important.  My problem was misdiagnosed.  I have the same pupils, and can see so clearly, inside as well as outside.  Just so sorry that it took me so long to get another opinion.
WHen having a problem that is not addressed by your doctor.  It is time to seek another opinion.

[JodieJ]

K-D, I'm very glad to learn about your improved ReZoom vision!  As you stated, the multifocals are new technology, and it seems like most docs are still on the learning curve.  I've read reports about a variety of procedures that have really improved the vision of some people:  laser vision correction, surgery to recenter the IOL, receiving a second multifocal implant, (and now) YAG.  But none of the above procedures have worked for everyone.  Within the past month, I've seen reports in Eye World and the EyeQ Report of the ASCRS 2007 Symposium stating that a small percentage of people never neuroadapt to the multifocals.  (Susan from Seattle, your intuition about your ReStor vision appears to have been right on target!)  RHS, you may be in this group, and I truly empathize with your misery and frustration over the past year.  On the positive side, there are posts in the archives (e.g., from Blue92) who obtained excellent vision when their multifocals were replaced with monofocal lenses (after more than a year of bad vision).  

[JodieJ]

If you check the archives of the Optometry forum, you will find several posts from people who have had their multifocal lenses successfully explanted (after several months to more than a year) and replaced with monofocal lenses.  It is now reported in the medical literature that a small percentage of people are never able to adapt to their multifocal IOLs.  Best of luck with your surgery.

[RHS]

I share your pain. What ever you do next don't let the doctor stretch out your waiting period for your vision to improve. I have two Restor lense implants which are now  one year old. My vision was bad from the start and has never gotten better. I tried every thing that my doctor suggested to improve my vision. Contact lenses, laser surgery to correct my astigmatism, etc I can't see well at any focal length. Near vision: my two eyes do not focus at the same reading distance. They don't work at all in low light situations. Middle distance is non-existent in good light and poor light. Far distance works fairly well during a bright sunny day, however at night the rings and halos are so bad that I am unable to drive at night. To read this forum my head is plastered up to the computer screen to recruit my near vision blurry as it is.I am now scheduled to have my first Restor lense removed on June 20th by a different surgeon at my expense. The second will follow. What ever you decide to do, don't wait like I did. Basicly my life has been hell for 12 months. And to top that off I am not confident about the surgical proceedures I now face. It seems, by what I have read that if you choose to explant that you should do it withtin three months. By the way, my vision never improved once the second eye was done. I thought all along that it was the astigmatism but it was not.

Hopefully, some other people will respond to offer insight on our problems.