ReZoom Lens Implant Surgery A Success

I recently had a ReZoom Lens implant with my right eye and my left had a ReZoom Lens implant last year.  I have been extreamly pleased with the ReZoom Lens and glad I made the decison to go with this type of implant.  I am extreamly near-sighted and now my distant, mid-range, and close vision is perfect.  I do have computer glasses for extended time in front of a computer screen, however overall I'm very pleased with the technology.  I'm also a pilot and have had no issues with obtaining my medical certificate.  It makes a big difference who is conducting the surgery and I would recommed finding a well-know medical doctor with years of experience to assure the best results.  

[gntr]

Fabulous!!! Are you getting paid by AMO? Because I can't believe that those garbage lenses will ever give anybody decent vision!

[Ray T Oyakawa, MD]

Congratulations, I have many happy Array (first generation ReZoom) and ReZoom patients.

The main problem in my opinion is trying to determine who will be among the 5% who will not neuroadapt to the glare and halos.

[gntr]

Shame on you Doctor!! How could you state that only 5% of patients have neuroadaptation problems when in reality many, many doctors in group conferences have stated the deficiency of the Rezoom lense. Some going far enough to say that they would never consider using them on themselves. Doctor's have stated in this forum on previous postings that they would not consider using Rezoom lenses on their patients.

Your statement is based on AMO Rezoom's sales pitch and not on real life experience. Therefore, I believe your endorsement, in this forum, of this lense is reckless.

[JodieJ]

I don't believe that there are accurate figures about satisfaction (or lack thereof) with multifocal IOLs.  I've read that neuroadaptation takes up to a year, and 10% of the recipients never neuroadapt to multifocal vision (i.e., they can't see well at any distance).  The number of people who can't neuroadapt to glare and halos are an additional unhappy group.  I suspect that many multifocal IOL patients are unhappy with their vision but don't complain about it to their surgeons.  Some may simply stop driving at night or stop performing other activities they used to enjoy.

We all have different priorities.  Cataract surgeons depend on having good vision to perform their job, so it doesn't surprise me that they wouldn't want ReZooms in their own eyes.  But others hate wearing glasses so much that they would eagerly choose an alternative which promises they might be spectacle-free, even if it involves degraded vision.  There are probably many (some?) satisfied ReZoom recipients.  I do find Steve's post (above) a little suspicious, because he claims to have perfect near/distance vision with ReZoom yet wears glasses for intermediate vision.  (This is very inconsistent with the data about ReZoom, but who knows?)  BTW, I believe that Dr. Oyakawa has stated elsewhere on this forum that he no longer implants ReZoom or ReStor.

I'm personally aware of the stress and anxiety that vision problems can cause.  It doesn't make sense to me to take on unnecessary risk when blended vision with toric or aspheric monofocal IOLs works so well.  

[Ray T Oyakawa, MD]

I started implanting Array IOLs in 2000 when very few ophthalmologist implanted them.  They have been  my highest patient referral source for cataracts.  The referred patients ask me for the IOLs their friends had.  I have implanted multifocal IOLs in relatives, physicians, and eye doctors and their wives.

Patient selection, counseling,  and precise surgery are key for success in any multifocal IOL or premium IOL.  They all viewed Kevin Waltz's video about  halos and neuroadaptation. Kevin Waltz is an optometrist and ophthalmologist who has bilateral Array implants.


Most of my Array patients did not drive much at night and I hit IOL power target and fixed their astigmatism.  Some of these patients needed LRI or laser touch ups.  I have been asked by many of my colleagues about problems they encounter with presybiopia correcting IOLs.  Most have to do with missing target and having residual astigmatism.

It is surprising to me that many ophthalmologist do not track their results carefully, rely too much on their technicians, do not pay attention to details, and can not do LRIs.  This is the reason the Alcon Toric is doing so well.

If you hit target on any of these lenses and implant them correctly, problems patients are a small  minority.

Also, as Jodie mentioned, I no longer implant multifocal IOLs.  I can not predict who will not neuroadapt.  Of the two in-laws with ReZoom, one is doing great, the other has problems driving at night.  The second reason is that I can not predict who will develop macular problems.  One of my successful Array patients later developed exudative (wet) AMD and had to have the Arrays exchanged for monofocal IOLs to improve vision.  Multifocal IOLs split light.  I tell my Crystalens patients that if the surgery went well and I hit the target, the worse would be using reading glasses some of the time.  With multifocals, they may need an exchange.

There is no one prefect IOL nor are there any perfect medicines or surgeries.

My wife is developing a cataract and I am planning on implanting  Crystalens HD when she is ready.  I also implanted Crystalens in one of my referring optometrists who also had minimal bilateral macular  puckers.

If I needed cataract surgery at this time, I would choose a Crystalens HD.

[JodieJ]

Thank you for your comments.  Perhaps there would be many more happy multifocal patients if all cataract surgeons had your skills.

Many people reading this forum are contemplating cataract surgery.  It would be very helpful if you would post information about your experience with the Crystalens HD.  Specifically, how much accommodation should patients anticipate from this IOL, and how would you recommend the IOLs be set (e.g., mini-monovision?)  Are there any contraindications?

I would also be interested in any comments you might have that might help people to choose a cataract surgeon.  When I was choosing a surgeon, I limited my selection to board-certified doctors who were experienced in both cataract and refractive surgery.  Is this a strategy you would recommend?

[starman6600]

Thank you for all of your good information. Like Jodie, I appreciate all of the comments that you share with us.  I am learning that the CrystalensHD is an excellent lens and would like it for myself if possible.  I am a 67 y/o male with early cataracts and am considering an implant in the near future.  I am post RK (surgery was 1992) and have developed hyperopia (+1.75).  Given the preliminary information which I have provided about my case, would you consider implanting the CrystalensHD in a patient such as myself.  If yes,  can you project what type of outcome might be the realistic?   If you would not consider implanting the CrystalensHD, what would be your lens of choice (please be specific as to brand and model) for a post RK individual such as myself?  Thank you in advance for any comments you can share.

[Ray T Oyakawa, MD]

I have implanted about 50 Crystalens HDs.
            1)  Near is about 1.5 lines better.  Most patients see J1 to J2.  This is the distance eye (dominant).  Most near eyes are J1 to J1+
            2)   Target is easier to hit.  Of the 31 stable patients 85% are within + -.25 of target.  The two worse eyes are +.75 and -.75 from target. Not so with AT50 and AT45.
           3)  I  target the dominant eye for plano and the nondominant eye for -.50. Micro monovision. For the AT50, I targeted plano for the dominant eye and -.75 for the nondominant eye.
           4)   I do vector analysis on all eyes with Alcon Toric calculator and correct astigmatism of .75 or more by an LRI or by moving my incision.  For the LRI, I use Nichiman's NAPA nomogram. This is a depth and age adjusted nomogram.  I presented a poster at ASCRS which showed a 96% success rate of LRIs at the time of cataract surgery.   http://www.ophthalmologyweb.com/Spotlight.aspx?spid=23&aid=281

I use the Crystalens HD for the following reasons:
        1)  I don't have to worry about pupil size or mild macular pathology, present or in the future.
        2)   I don't have to worry about neuroadaptation and the possibility of an IOL exchange.
        3) Crystalens have less contraindications compared to the other two.  I have implanted them in diabetics, post retinal detachment, macular pucker, mild amd, etc. patients.  


However:
    1)  IOL is more challenging to implant compared to a ReZoom or Restor.  
    2) Target is harder to hit compared to a ReZoom or Rstor.
    3)  I use atropine at the end of surgery and have the patients use reader for two weeks post op to prevent a myopic shift.  This results in less of a "wow" effect.
     4)  More and earlier yags are needed.
      5)  More post op chair time is needed and I charge appropriately.

Finding an eye doctor:
      1)  Look at the Crystalens website for a doctor.  Look for a Center of Excellence in your area.
      2)  Many younger doctors did not do RK and are not as familiar with LRIs. This is a general statement.  I know many older docs who do not do LRIs and younger docs who do.
       3)  Ask about their experience,  Do they implant all premium IOLs, do they do LASIK--a plus.  LASIK surgeons are not afraid of touching up a small refractive error.  Also small myopic refractive errors change be touched up with a two cut mini RK in the office.  When did they start with these IOLs.  The CMS ruling was in mid 2005.  However, most ophthalmologist did not start presbyopia correcting IOLs until 2006 or 2007.

       4)  Get a referral from a friend you trust who has had a presbyopia correcting IOL.

        5) Board certification is plus.

       6)   Finally ask the staff and the doctor about their experience.  You would be surprised.  One of my staff called a competitor and was told by the staff he was just getting started.

[Ray T Oyakawa, MD]

I have implanted Crystalens in post RK patients.  I believe as do others that the RK cornea give some multifocality and Crystalens is a the best choice for presbyopia correction cataract surgery.  If target is achieved,  you can expect good distance and near acuity--J1 to J2 range.


Multifocal IOLs can result in an increase in unwanted symptoms due to the multifocal IOL and the multifocal cornea.

The same applies to post CK or LTK eyes.  I am following an unhappy ReStor patient who previously had CK.

[JodieJ]

Dr. Oyakawa, thank you so much for posting this detailed information, which will be extremely helpful to many forum readers.  I'll try flag this thread to make it easier for people to find when searching the archives.

[twochicklets]

This is an excellent thread.  I follow this forum due to a problem I had with my cataract surgery and double vision.  I had the rezooms implanted before I read of all the complaints.  Aside from my problem with the surgery itself, I am kind of pleased with the rezooms.  I do use readers for computer and reading, but I can get by in a pinch without them.  My only complaint with the rezooms would be night vision, not the glare and halos because they have improved immmensely in 6 monthes, but night vision itself.  In a dark room, I see much less than I used to and that does bother me.  I know it is because the multifocals split the light, and I didn't fully understand how that would manifest- I do now!!

[Ray T Oyakawa, MD]

Try alphagan.   This is usually used for glare and halos at night.  However, the smaller pupil with alphagan may also improve your night vision.

[starman6600]

Thank you Dr. for your detailed and excellent comments.  This is so very helpful.