ReZoom lens replacement in one eye only

[newflora]

I have a stage 3 cataract in my right eye and a stage 1 cataract in my left eye.  For several years I have been using my right eye to see things close up and my right eye for distance.  This has not been a problem for me and I have not had to wear glasses.  

Now the cataract in the right eye has progressed to the point that I am having trouble seeing things close (computer range) with my right eye.  I was thing of having the lens in my right eye replaced with a ReZoom lens now and wait on having my left done until the cataract reached a stage three.

The ophthalmologist would only consider doing both eyes with the ReZoom lens, RESTOR lens or a combination of them.  If I only wonted to do one eye, I would have to use a mono contact lens.  He did not explain why other than it was “his policy.”  

What kind of problem would I encounter if I only had my right eye done with a ReZoom lens and not have anything done to my left eye until the lens needs  replacement?

[John C Hagan III, MD, FACS]

We receive many more problems and complaints about multifocal implants than the standard monofocal. I suggest you use the search feature on this page and search the terms: multifocal implant, restor, rezoom, crystalens. Bottom line the multifocal implants cannot guarentee that you will not need glasses some or all the time, your night vision may not be as good, you will pay more and there is a higher chance of the implant need to be removed-exchanged.

JCH Eye MD

[shrlzi]

I had a ReStor Multi-focal IOL implanted (cataract surgery) and was shocked at the problems with night driving. I had not really been warned at all. I was told they were not recommended for professional drivers who drive at night; I didn't realize I would be unable to drive at all at night because of halos that appeared to be rings of light around signal lights, car headlights and taillights, street lights, etc... which totally obsured anything near the lights, and could not read reflective street signs. I could still drive at night with glasses, because I could close the Restor eye when glare / halos became bothersome and drive one-eyed through my early-stage cataract eye.

The doctor wanted to schedule the second eye right away, citing literature (from the mfgr) that they 'worked better' if both eyes are implanted with multi-focal IOL. I refused, because I was so unhappy with the vision with ReStor lens. I asked about changing to a regular lens, and he said replacement surgery is much riskier than the original surgery and discouraged me from doing that.

I did an online literature search and found studies showing that some people take up to a year to get accustomed to the MF IOL, so I decided to give it up to a year. Now it has been about 8 months, and the halos are not quite as bothersome, only noticeable when a light is particularly bright, like a badly aimed headlight or high beam (when I still feel safe only because I can close the IOL eye and the halo disappears).

I also found a study (sorry I can't cite it) that showed even people who say they are not bothered by halos can locate them and measure their size.  So, this is clearly something that doesn't go away, but the brain learns to accommodate.

I feel very frustrated because I can't find anything about mixing multifocal and monofocal IOL -- just "MF IOLs work better when both eyes are implanted" -- no research backing up this claim, or explanation why it is so, or investigation of results when eyes have different types of IOLs. Not even personal anecdotes (so far at least) of people who have mixed lenses. I asked my surgeon if he could refer me to studies, and he sent me promotional literature from the mfgr!  I called the company and they listed to my story and said they would add my report to their database.

I would like to see them change their advertising literature to more strongly warn people about the potential for low-light vision problems!

I have 4 more months before my year is up; I'm still waiting to see if I accommodate better to the halos. I may have years before the cataract in the second eye is bad enough to really need surgery.  I am hoping that, by then, more will be known and maybe even a better lens invented.

If you have any comments on why it is 'bad' to mix lenses, I would really appreciate it.

[John C Hagan]

I've asked a friend of mine that edits a medical journal on refractive surgery for comments and his extensive experience. It may take a day or so for me to get a comment but I'll try and find out for you.

My surgical preference is mono-focal implants so I rarely encounter problems like this. I'll also check our data base and see how many patients have a multifocal in one eye and a monofocal in the other.

JCH MD Ophthalmologist

[John C Hagan]

This responce is from an internationally know eye surgeon that edits a medical journal on cataract & refractive surgery. He read your posting:


Feel free to pass on to the patient.



Alcon’s biased stance ( I have owned Alcon stock within the last year and do implant the ReStor, see below ) is to not mix the lens.  I tell patients emphatically they will notice halos.  Risk of noting halos, starburst, problems with night driving:  1) silicone monofocal ~ 1-4%, 2) acrylic monofocal ~ 5-8%, 3) crystalens ( silicone accommodating ) ~ 8-10%, 4) Restor ( acrylic multifocal ) 25-30%.



Multifocal lens by nature will have more night issues.  Most patients are less aggravated with the symptoms over time, yet ~ 9% of patients will complain of severe symptoms.  I do not implant the restor in both eyes because of lack of intermediate function so I do mix it with crystalens.  I think a monofocal or crystalens would not be an issue whatsoever.  There would be minimal to no night issues and it would not be problematic for the patient.  



By telling the patient they will have halo’s with multifocal a lot of patients will self select themselves away from the lens or if they do receive it they know in advance what the negative will be and also know it usually is less of an issue as time goes out.  In this scenario I have never had to remove a Restor.



Most surgeons also hate or never have removed a lens so it is typical for them to say keep the lens in as “ you will get used to it “.  In the majority of the cases for patient benefit the patients are better off leaving the lens in than having a surgeon who is either uncomfortable or inexperienced with removing an iol try to attempt an exchange.  The exchange is not like exchanging a contact lens.  There is significant negatives that can occur.



What to do?  I believe the patient will always notice the halo at night.  This negative has to be offset with good unaided near vision or the patient will always consider the lens to be a failure.  The price for reading without glasses with the Restor = a certain amount of night issues with point sources of light.  I hope this helps.

JD   MD    Editor  JCST

[blue92]

I have not visited this forum for a while since my last surgery, but I can tell you that combining a multifocal lens with a monofocal lens does not work well. If you read my past  postings you'll find a detailed description of my Rezoom journey. I had rezoom lenses in both eyes for about a year. I waited for the magic to work, however, it never did. Halos ghosting, lack of contrast and poor intermediate vision forced me to have the lenses explanted. It wasn't easy finding a surgeon willing to do the exchange, but thankfully I did eventually find a qualified and caring surgeon willing to help.

The rezoom lenses were explanted two months apart so for that period I had a monofocal and multifocal lens. I loved the monofocal lens ( no aberrations whatsoever) and hated the rezoom even more. The second eye was set slightly nearsighted for better intermediate vision and some near vision. The outcome exceeded my expectations The blended vision is totally aberration free and for most of the time I don't use glasses. When I do, for reading, I use +.75 readers.

Good luck with whatever decision you make, however, if you are unhappy with the Restor lens don't have the second implanted as you'll only exacerbate you condition and end up with more noticeable aberrations. Your present problem times two. I made the same mistake thinking that the second rezoom lens would resolve all the problems. It didn't, it made it worse.

It has been a very difficult journey, but I'm glad is over. I love my monofocal lenses and only wished that I had them implanted in the first place.