ReStore lens problem

I am a very active 51 year old and I depend on excellent vision for competition Taekwondo.  I  have never worn glasses and hate the thought of being dependent upon them for good vision.  Prior to my catatact surgery on December 15, 2007, my vision was 20-15, I chose the Restore Lens in hopes of not needing correction after my surgery.  It has now been over 4 weeks and my vision is terrible.  I have 20-40 vision and every thing is cloudy.  I did some research and I believe I am experiencing VVD, or Vasaline Vision Dystrophia.  I am having the lens replaced in a few weeks, but I do not know which lens I should have reimplanted.  Please help me someone!  My doctors are not sympathetic and feel that I should be happy that I have this degree of vision.  There argument is that only a few years agoe, people undergoing cataract surgery were forced to were bottle-thick glasses following their surgery.
I am grateful fo any advice.

[cdn_glenn]

The difficulty with multifocal IOLs is that they don't seem to support all near, mid and far ranges in a single lens.  You will most likely have to trade-off a range (usually mid vision) for the other two.

I read the article in EyeWorld on Vaseline Vision Dysphotopsia.

http://www.eyeworld.org/ewweeksupplementarticle.php?id=262

As you can see there are other posters on MedHelp with the same complaint.  Bottom line in the above scenario is explantation.

I was reading the most recent edition of Cataract & Refractive Surgery Today.  The article IOL Options in 2008 is a round table between several refractive surgeons.

http://www.crstoday.com/PDF%20Articles/0108/CRST0108_07.php

About a third way down is a section discussing "Waxy Vision and Higher-Order Aberrations".  There is some interesting discussion and possible alternatives to explantation.

Regarding which lens to choose after explantation, possibly another ReSTOR with a different prescription could work, but a sure thing is an aspheric monofocal lens.  This you will need to discuss with your doctor.  Both you and he need to be comfortable with the decision.

Good luck and let us know what you decide,
Glenn

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

First I would accept the idea that you will need glasses for many things after surgery no matter what type of IOL you decide to get.

I recently attended a two day seminar of several hundred eye surgeons and the questions was asked who would have a multifocal IOL inserted in their own eye. There were only 4 surgeons that said they would and of those the only one they would consider was the Crystalens. They all said that no matter what they would not accept of ReZoom IOL.

97% of the surgeons said they would opt for a MONO focal IOL specifically the Tecnis aspheric IOLs. Those that wished to minimize dependence on glasses would aim for a post op refractive error of -0.25 in the distant IOL and -1.25 in the reading eye.

Think TWICE BEFORE YOU LET THEM PUT ANOTHER RESTORE IOL OR THE EVEN WORSE REZOOM IOL IN YOUR EYE.

JCH III MD

[JodieJ]

Skip the ReStor in any Rx.  Go for an aspheric monofocal lens.  There are 3 on the market:  the AcrySof IQ (Alcon), the Tecnis (AM0), and one from Bausch & Lomb.  (Go to www.tecnisiol.com for more info about this lens.)  Monofocal IOLs can be set for monovision or modified monovision, if (some) freedom from glasses is your goal, but I don't know how this might affect Taekwondo.

Shame on your doctors.  If there is another experienced, board-certified surgeon in your area, you might consider switching practices before the explant.

[cdn_glenn]

Sorry to weigh in again about multifocal IOLs.  I'm still under the impression that multifocal IOLs work better in pairs.  But I also have read many articles where refractive surgeons have placed a monofocal or an accommodative IOL into a patient's second eye with excellent results.  I am certain the monofocal combination will work well.

Also, Julie please use the Search function at the top-right of this page to read more on the Tecnis aspheric IOL.  There is much discussion on this board regarding this, and it has been deemed extremely reliable.

Regarding monovision, if you're involved in Taekwondo I believe depth perception is very important.  The best response I've seen was in a thread answered by Dr. Hagan regarding "Monovision surgery for athlete":

http://www.medhelp.org/posts/show/313739

It gave me quite a chuckle and I had to look it up again.  JodieJ gave some very useful advice on testing monovision.

[JodieJ]

Based on Julie's post, I assumed that the ReStor implanted in December was her first surgery.  Julie, if you already have a ReStor with good results in your fellow eye, then maybe you will have to consider another multifocal/accommodating lens.  However, two ReStors might give you impaired intermediate vision--not very good for many activities, including athletic ones.

Actually, any of the three aspheric monofocal lenses would be desirable without a ReStor in the fellow eye.  Both monovision and modified monovision can be easily reversed with a contact lens or glasses for athletic activities, if desired.

[cdn_glenn]

Oops!  May have confused Julie's post with "Dim Vision After Cataract Surgery" by JustJeanne.  JustJeanne already had a one good ReSTOR implant, but the second is having difficulty.

Julie, if the ReSTOR lens is in one eye and the other is untouched then I think it's best to use a monofocal lens after explantation of the ReSTOR.

Cheers,
Glenn

[Laura4]

Reading back to Jan 18th posts, why why why are so many eye surgeons advertising (some agressively) multifocul lenses when only 4 of several hundred would use them in their own eyes??  Just last night I went to a lecture at my fitness center given by an opthamologist.  He used a power-point presentation on ReStor and Toric lenses all with cheerful outcomes.  In fact, he pointed out that we were more likely to die in an auto crash than from a ReStor Implant.  Maybe the auto crashes are caused by implantees driving at night.  I considered asking that but instead asked - where does near vision end and distance vision begin and what happens inbetween?

I've been reading your posts for several weeks because of problems I'm having after a Toric SN60T3 was implanted on Jan 23, 2008 in my left eye.   The surgeon was excellent and the placement and alighment was "perfect", but I'm learning now that there's so much more to vision than good acuity (ie 20/20 vision).  I was blessed with excellent eyesight until  the ordinary need for reading glasses that comes with age - 1.50 worked for me.  Having cataracts in both eyes I was offered the ReStor lenses but refused.  I had 1 diopter of astigmatism and on recommendation went with the Toric lens.  I canceled the surgery for my right eye (also to be same Toric) because of the degree of anxiety I'm having with this left eye.

Here they are...shadow arc on temporal vision (least problematic), a fluttering light that looks like it comes through clear gelatin off edge of lens - can be intense and takes up more visual field than the arc.  Glare.  Night vision is much much worse with large halos and blury vision.  The most difficult is also most difficult to describe.  It is an over magnification that looks unreal and unworldly and it has not simmered down.  I've actually had nightmares about it.  Is this because of the present imbalance between eyes?  

I've heard that it is riskier to explant a Toric.  Is that true and when would be too late?   As a landscape designer/naturalist type my well being is in my vision much more than I ever thought.  Fortunately am also a musician and am leaning on ears for now.

Thank you for reading this long post
Laura4