ReZoom & ReStOR lenses

[CKLG]

I am 50 years old and had ReZoom lens implanted in my right eye on Oct. 2/07 & ReSTOR lens implanted in my left on Oct. 11/07.  Before my surgeries my prescription was 20/-675, needed bifocal glasses of +200 and suffered from dry eyes all the time.  After being diagnoised with cataract on my right eye 2 years ago, my eye doctor recommended me to go for a CLE (Clear Lens Exchange) operation in order to have better vision at younger age.  Since day one from surgery, my right eye has been bothered by glare & halos.  My distant vision outdoor under natural light is good - 20/20 for right eye; 20/30 for left.  My left eye with the ReSTOR lens can read perfectly under bright light.  My right eye sometimes has 80-90% of reading abilities, sometimes not.  Now it's 3 months after my two eyes' surgeries, my right eye is still bothered by glare.  It seems that it cannot adapt to artificial lights at all.  It can only see well outdoor but as soon as I am in a room or under any aritificial lights, my vision becomes blurry instantly.  The halos appear smaller now and I can only see them from street lamps or head/tail lights far away.  Once those objects are nearer, I don't see them.  My eye surgeon just prescribed me the ratio-brimonidine to treat the glare.  Now I don't see light rings when I blink but the glare is still there.  I am now wearing a pair of light shade sunglasses while typing on the computer.  My main concern is that I DON'T HAVE ANY INTERMEDIATE VISION.  From all the information I read on the web site the ReZoom lens is supposed to give me good distant & intermediate vision.  Why is it that everything around me in the room is blurry?  I can't see the $ amount on the cash register in a grocery store; I can't see the nos. on the telephone dial pad; I can't even see the words on the document on my desk in the office; I can't see the words on a stove unless I press my face to the screen.  Didn't the web page indicate that the adjustment period for ReZoom lens is 6-12 weeks?  Didn't AMO claim that ReZoom give very good distant, intermediate & close vision?  Is my blurry intermediate vision caused by the glare OR by my dry eye condition?  I still need to use Systane eye drops & Liposic regularly.  Will my intermediate vision ever return or are my eyes doomed after the surgeries?  At my last visit 2 days ago my eye surgeon also found out that my eyes did not heal well.  I now have fibroids on the membranes which may need laser surgery.  With my extreme dry eye condition I am definitely not a candidate for laser.  I am very frustrated and afraid.  Will any eye experts be able to answer some of my questions or calm my fear?  I have debated for the longest time before my surgeries.  Finally I decided to spend $$$$ to get rid of my cataracts & poor vision at a younger age, hoping to see better sooner & longer.  Now it seems that I spent my money in vain.  If my message scares anyone who are considering to have a CLE operation, my apology.  I have heard many people who have had good results after the surgeries.  I am just one unlucky one, I guess.

[John C Hagan III, MD, FACS]

You had better make your peace with wearing glasses most of the time. These two websites have a huge number of postings on your problem. You can find them by reading previous postings, using the search feature and health topics.

There are also a number of very kind "regulars" of these eye forums who have been through what you are going through now and often answer with detailed discussions.

JCH III MD

[lsnstr]

Your story sounds very similar to mine. I also had very poor intermediate vision which was worse at night. You are correct, according to AMO, the adjustment period is 6-12 weeks. I guess the acceptance period is 12 months (acceptance meaning that during this period you learn to live with bad vision. The reason why you have poor intermediate vision is because the intermediate vision is given by the transition rings of the lense - thus limiting the amount of light required for intermediate vision. I had my lenses explanted because of halos and starbursts; however, the most debilitating issue was lack of intermediate vision (i.e. not being able to see the computer screen unless you move 12" away from the screen -same problem at stores, etc.) It is highly unlikely this will improve. It did not in my case and I had the lenses for over a year.  Good luck!

[CKLG]

I didn't know about this web site before my surgery.  I went for my surgeries based on my faith on my eye doctor's recommendation.  Why didn't she mention about your web site for me to read?  I might have settled with a pair of thick progressive glasses and several brands of eye drops!  Now it's too late to cry over spilt milk.  I have read up to page 11 of your forum.  I would still like some questions answered:
(1) Have you heard of fibroids on membrane?  I didn't come across this healing problem on the forum.
(2) I am reluctant to go for laser removal of these fibroids given my extreme dry eye condition.  What is the risk of not leaving these fibroids untreated?  Will I go blind eventually?
(3) The ratio-brimonidine did help eliminate the light reflections though it makes my eyes even drier.  How safe can I use this kind of medicated drops?  
(4) At this moment, i.e. 3 months of post-surgery, I have good distant & reading vision.  Would my eyes ever give me intermediate vision or 3 months proved the surgery failure?
I hope you or someone will be able to answer my questions instead of asking me to just read over other patients' responses & experience.  Thanks a lot.

[CKLG]

Thanks for your reply.  You said you had your lenses explanted - does it mean that you have the ReZoom lenses removed from your eyes?  If so, what lenses do you have in your eyes now?  I forgot to ask AAO-MD-JH the risk of having implanted lenses removed.  Why didn't anyone, not even my own eye doctor who referred me to the eye surgeon, give me all this (risky) information before the surgery??  So I presume after 3 months if I don't have any intermediate vision, I will not have it in future AT ALL.  Am I correct?

[lsnstr]

Yes, the Rezoom lenses were removed and monofocal lenses implanted. I have Tecnis lenses and they are aberration free. Contrast and general vision is great day or night. Unfortunately I made the same mistake. It sounded too good to resist. I’m glad for this site. Although a little late I was able to understand the problem and my options. There are many postings that deal with your problem.

[Snooky655]

I just read your posting, I'm new to the site, about having your Rezoom lenses taken out.  I had the ReStor lens implanted 6 wks. ago and now I have a dry eye, blurring vision in any artificial light, halos and starbursts at night.  With the Tecnis lens, do you have any more of these problems?  How is your intermediate distance vision?  Do you just wear reading glasses now.  I play a lot of tennis and am concerned about the distance, intermediate, close vision transitions.

[CKLG]

Thanks for your reply.  Did you have the ReZoom lens removed from one eye or both?  My main concern is that there is NO risk or complication after the removal?  My eye surgeon told me there were risks related to removing implanted lenses.  Thanks for being patience in answering my question again.

[John C Hagan III, MD, FACS]

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[lsnstr]

I'm going to address the last two postings.  With the Tecnis lenses, I no longer have halos, starbursts, contrast problems or any other aberrations. I do enjoy clear, crispy vision day and night. I did have some dry eye after the surgeries which blurred my vision a bit, but since that has subsided, the vision is very good.

I had both lenses explanted. Mixing monofocal with multifocal does not provide good vision. Definitely not a good match . Having read several postings and at the suggestion of my doctor, I have my dominate eye set for distance and the other eye for intermediate distance. My eyes have adjusted quite well - so for intermediate and long distance, day and night, my vision is very good. I do require low power reading glasses for reading and close up work. As for shopping, sports and non-working activities, I do not need glasses. I drive fine without glasses and can see the dashboard, GPS, etc. without any problems. The best way to describe my vision is that I can see my watch without glasses (arm extended), dial the telephone, etc, without a problem.

As for risks and complications, you have the same risks as for whenever you operate on the eye - risks ranging from simple inflammation to blindness and everything in between. This surgery is by no means risk free. Those were the chances I had to take, but at the end it was worth it. Besides dry eye which is much, much better, the surgeries went very well. I only use one drop of Systane in the morning and I do fine the rest of the day.  I hope this helps.

[vo123]

Wow!  I wish I found this website BEFORE my surgery.  I have problems with double vision with Rezoom.  I blame my doctor for encouraging these lenses.  I am seeing other doctors since I desperately want these explanted.  How can I be sure of the potential explant doctor's qualifications?  What do I look for?  I felt my original doctor had good qualifications and am so disappointed with him.

[kris17]

Try to get a consult a major teaching university - you have a better chance to talk with doctors who keep up on the latest research literature (rather than rely on sales reps from companies).  Ask various optometrists in the area (make sure no financial entanglements) for their suggestions.      

[JodieJ]

Other ophthalmologists are the best source of who is good.  Board certification is a minimal qualification; I think you'd also want someone very experienced.  If you live in/near a large metro area, you might try using Castle-Connolly's directory, which lists board-certified surgeons whom other doctors would want to see themselves (www.castleconnolly.com).  At the consultation, ask the doctor how many explant procedures they have performed (and how many with ReZoom).

You have nothing to lose by expressing your dissatisfaction with your ReZooms to your surgeon.  You might even quote some of Dr. Hagan's recent comments about ReZoom.  (Perhaps you can spare another patient some stress and frustration.)  Your surgeon should be knowledgeable about who is experienced doing explant procedures in your community.  From what I know, it's better to do the explant sooner rather than later.

If you live anywhere near Indianapolis, Dr. Kevin Waltz has successfully explanted multifocal IOLs from several people posting here.

[CKLG]

I just came back from my eye surgeon's office.  After 5 months with the ReZoom in my right eye and the ReStor in my left eye, I have excellent distant vision & good reading vision.  But any words between 2&8 feet are blurry except they are in bold or big print.  In bright daylight my mid-vision is slightly better (not 100% clear & sharp) but not in dim light. I am still experiencing glare & halos.  The halos around headlights or street lamps don't bother me much since I always saw fuzzy lights when I had cataract before surgeries.  What bothers me the most is the starbursts at the upper corner of my right eye under artificial lights.  My eye surgeon now suggests me have these lenses explanted and replaced with Technis lenses.  My questions for you:
(1) What are the risk involved with this unusual surgery?  I am afraid of long term health effect on my eyes if I have my lenses removed twice such as damaging lens capsules, potential retina detachment, more scar tissues on membrane after 2nd surgery, etc.
(2) My eye surgeon recommends one eye set for distant and the other one slightly off to provide moderate intermediate vision.  I am now torn between living with my current lenses with good distant & reading vision or going through unknown risks and living with good distant, moderate mid-vision but no reading power.
(3) Is this called monovision?  I tried monovison contact lenses before but couldn't adapt to them.  I had headache with distinctively different vision on each eye.
(4) How long did you have your multifocal lenses removed after the implant?  My eye surgeon recommends me done sooner than later.  I am very afraid of the potential risks (not caused by the incision but by the lens removal).
Thank you for your kind advice.

[John C Hagan III, MD, FACS]

You are talking about a lot of surgery and significant risks. You and you alone can determine whether your present situation warrants taking these risks. I would suggest you get a second opinion from another IOL Eye MD surgeon.

Ricks (times two since you are talking both eyes) include infection, bleeding, retina detachment, IOL power being "off" and a small risk of loss of the eye.

No its not mono vision which is one eye for distance and one eye for reading and glasses for intermediate. In any case you are going to need glasses for many things either way.

Get a second opinion. FInd an Eye MD at www.aao.org

JCH III MD

[CKLG]

Thank you for your response.  Your comment is exactly what I am thinking now.  The ReZoom lens is not giving me the benefit it claims - good intermediate vision.  Now I have excellent distant vision and good reading ability on both eyes.  If I have my lenses explanted and replaced with the Technis lenses, I will have regain my intermediate vision but need reading glasses.  In either way I need a pair of glasses.  My only struggle is to decide if I should go for the risks for an explant in exchange of no glare.  My eye doctor told me the glare might diminish when my pupils got smaller over aging.  My eye surgeon told me the glare might never go away and he recommended the explant to be done sooner than later before the lenses settle in the eyes longer.  He will book me an appointment to see a surgeon specialized in explaning lenses.  I won't make a decision till after my appointment.  In the meantime, I won't opt for explanting the lenses in light of all the potential risks, which should be more significant than my first (cataract) surgery.  I hope that over time the glare will be reduced if not completely eliminated (sigh).

[John C Hagan III, MD, FACS]

Good Luck.
JCH IIIMD

[CKLG]

I thought I posted my questions earlier but couldn't find them.  I will address my issues again.  Dr. Hagan, while I have decided not to have my lenses explanted, I was told by my eye surgeon that I have developed mild capsular fibrosis and he recommended YAG Capsulotomy to be performed.  My concerns:

(1) Can I leave the fibrosis untreated since it doesn't affect my vision to a great extent yet?

(2) If the fibrosis is left untreated, will it get worse in future?

(3) How safe is YAG Capsulotomy?  I understand it will have potential risks of retina detachment & lens dislocation.

(4) Is capsular fibrosis a common post-op symptom?

(5) After YAG Capsulotomy, will it pose any risk to future eye surgery should it be necessary?

Thank you for addressing to my questions again.
CKLG

[John C Hagan III, MD, FACS]

1. Generally yes
2. Sometimes yes and sometimes no
3. Very safe, the safest of any procedure we do. REMEMBER. DRIVING AN AUTOMOBILE IS GENERALLY SAFE BUT ITS NOT RISK FREE.  The risk of IOL dislocation is very small. The risk of RD increases perhaps 0.5-1.0 % in highly myopic individuals. In eyes that were not highly myopic prior to cataract surgery the risks are much smaller. The high risk patient is a middle age highly myopic male with a family history of RD. They should have a detailed retina exam before the laser, one week after the laser and 6 weeks.
4. Extremely common almost routine. About 1 in 4 people having IOL cataract surgery in 2008 will need a Yag sometime. In 1985 the figure was about 1 in 2 in 1978 it was about 3 in 4 and there was no Yag so it meant another operation to open the capsule. Progress is wonderful.
5. No except if the IOL needed to be removed or explanted it makes it more difficult.

JCH III MD

[CKLG]

Dr. Hagan, thank you so much for your prompt & encouraging reply.  Forgive me to ask one more question:  I have dry eyes (need to put on artificial tears frequently).  Is it safe for me to have a YAG capsulotomy?  Will the surgery make my eyes drier in future?  Thank you again for your time in addressing my concern.
CKLG

[CKLG]

Sorry, Dr. Hagan.  I forgot to ask one more question after sending out my previous email too quickly:  besides concern on my dry eye condition if my eyes are suitable for YAG capsulotomy, I also would like to know after this laser treatment, will the symptoms reoccur?  Thanks for your patience with me.
CKLG
*****************************************************************************************************
Dr. Hagan, thank you so much for your prompt & encouraging reply.  Forgive me to ask one more question:  I have dry eyes (need to put on artificial tears frequently).  Is it safe for me to have a YAG capsulotomy?  Will the surgery make my eyes drier in future?  Thank you again for your time in addressing my concern.
CKLG

[CKLG]

I thought I posted my comment to you earlier this morning but apparently I didn't.  Since I have complained of unbearable glare & poor intermediate vision since the implants of the ReZoom & ReStor lenses last October, my eye surgeon just made me an appointment to see an eye specialist on April 17th for discussion on explanting the existing lenses and replacing them with the Technis aspheric IOL.  My immediate questions & concerns are:
(1) Will the Technics lens give vision as "clear" as the multifocal lenses?
(2) After 6-months post-op, my eyes seem less focused than before.  Will the Technis lens give more stable vision?
(3) My eye surgeon suggested mono vision on new lenses should I choose to explant my multifocal lenses.  I was -6.50 OU and tried unsuccessfully with mono contact lenses before cataract surgery.  Will a -0.50 setting in non-dominent eye provide adequate & functional intermediate vision?
(4) I was told that I have developed mild capsular fibrosis.  Will explanting lenses create more scar tissues (fibrosis)?

I understand there are major risks involved in explanting lenses.  Therefore, I try to gather as much information as possible before my April 17th appointment.  Thank you for your continual attention to my eye problems.

Look forward to receiving your reply.  Gratefully,
CKLG

[John C Hagan III, MD, FACS]

1. Generally better than multifocal
2. Usually yes, no guarentees
3. Extreme monovision is very hard to adjust to unless a person has done it for years with contacts. Most Eye MDs suggest -0.25 for distance  -1.25 for intermediate and for reading and "best binocular vision" progressive bifocals.
4. Generally no but at some point the fibrosis will probably require a yag laser capsulotomy.

JH III MD

[CKLG]

Thank you so much, Dr. Hagan, for your prompt reply.  I really hesitate to have my lenses explanted though I find in the last couple of months my vision is not as sharp & focussed as before.  DO YOU THINK IT'S DUE TO THE CAPSULAR FIBROSIS?  WILL MY VISION GET BETTER AFTER THE YAP CAPSULOTOMY?

Thanks again & have a great day.
CKLG

[John C Hagan III, MD, FACS]

No way I can tell.
JCH III MD