Refractive Len Exchange

[jaunty19]

I would be interested to hear from anyone who as had this type eye surgery. What it entailed and if they thought, it improved their sight significantly.

[JodieJ]

Refractive lens exchange is essentially the same procedure used in cataract surgery.  During the past few weeks, there have some very unhappy people posting about their experiences with RLE and Crystalens.  And I definitely think that you should avoid RLE with ReStor and ReZoom.  Do a lot of homework before proceeding.

[John C Hagan III, MD, FACS]

Within the last two weeks I have been to a two day meeting about state of the art IOLs and also reviewed a two issue medical journal about  these IOLs.

The eye surgeons in attendance stated that they would almost always chose a monofocial apheric IOL and wear glasses over them. If they wanted some freedom from glasses they would use a modified form of mono-vision.

Many to most have stopped inserting the ReZoom IOL do to many, many problems.  

Since you can see with glasses you need to ask yourself if you are ready to accept the risks of cataract surgery without having a cataract.

JCH III MD

[jojokiki]

I had an Alcon Acrysof IQ IOL inserted after cataract surgery in my right eye- achieving beautiful distant vision.  Is that an aspheric IOL?  If not, would it work ok if I had an aspheric IOL inserted in my second eye after the other cataract is removed?   I do plan to end up with monovision- near vision in left eye.
Thank you

[JodieJ]

Yes, you have Alcon's aspheric lens.  (I have the same IOLs.)  AMO's aspheric lens is the Tecnis.  Bausch & Lomb also makes an aspheric lens.  Glad to hear about your excellent outcome.

[cdn_glenn]

I think I'm the only one posting in this forum that has undergone Refractive Lens Exchange (RLE) or I more commonly use Clear Lens Exchange (CLE) where one's natural lens is removed and an IOL inserted.  This is done, for various personal reasons, to improve vision.

Here's a article that came up when I plugged "Refractive Lens Exchange" into Google.  It's a reasonable primer on RLE/CLE:

http://www.usaeyes.org/lasik/faq/lasik-cle-iol-rle.htm

My decision to undergo RLE/CLE was not an easy one.  I researched on this board and on anywhere I could on the internet.  I read many medical journals on new IOL technologies, which ones were available and where, and success rates of each.  Procedures available locally were limited.  I could have possibly become part of a test group and had certain procedures done, but not what I needed.  With only one choice of accommodative IOL and two multifocal IOLs available in North America I searched elsewhere.  I am well travelled and found suitable IOLs and services overseas.

The results are the best part.  I can skip down stairways without holding the railing for dear life.  I can read the paper.  I can see what's happening around me.  All of it, very clearly!  Before this I was wearing bifocals and was prescribed trifocals, so I could do my daily (computer) work.  Scary for me.  My eyes could no longer change focus.  I could see in focus at 10" (25 cm) only.  I'm glad I did it.  It was a difficult decision, perhaps involving a little desperation.  Still I took my time -- maybe around 18 months from the time I determined I need to do something drastic (and more than Lasik).

But with the good there are sacrifices.  I chose multifocal IOLs.  There are issues with adapting to them.  Many issues resolved.  Many are here for eternity.  Among issues remaining are mid vision.  Between 18" and 4' (45 cm and 120 cm) vision isn't as sharp, and will probably never be.  I can read headlines and bylines, but not an article (unless I work at it).  If I pop on +1.00 readers I can see fine.  I also have to pop on the readers for computer work.  That's not so bad.  All my workspace is still in focus.  The other issue is ghosting where a second image, slightly down and to the left appears around bright objects like LED displays in elevators and signs with high contrast.

The decision was a tough one.  I am happy I went ahead with surgery.  I understood the risks and will live with any eventual corrections that may be needed.

Take your time if you're still thinking of RLE/CLE.  Do your research before making a decision.  Also, IOL technology is changing.  There will be more (definitely accommodative) IOL options in the coming years.

If you have any specific questions please ask.

Regards,
Glenn

[jojokiki]

What is a "modified" form of monovision?

[JodieJ]

Regular monovision targets one eye for distance vision and one eye for near vision.  The goal is to have "functional" (i.e., not "perfect") vision at all distances.  Many people that I know who have monovision never wear glasses.

Modified monovision has more modest goals.  One eye is targeted for distance and the other for intermediate vision (or intermediate and near vision), which provides better vision at those targets than regular monovision.  It is assumed that glasses will be worn some of the time (e.g., weak readers for many near vision tasks.)

Targeting both eyes for distance provides the best distance vision.  Progressive glasses would provide the best intermediate and near vision, relative to monovision or modified monovision.  So everything involves trade-off.

[CKLG]

Hi, Glenn.  Just curious to know what kind(s) of multifocal lenses you have implanted and when they were done.  I am around your age and have a ReZoom in my right & a ReStor in my left implanted last October.  I admit I am a critical person.  Now 6 months after post-op I find my right eye still has good distant vision (not as sharp & stunning as a couple of months ago), sufficient reading vision but blurry intermediate vision.  The distant vision in my left eye is ok but not good enough for night time driving; no intermediate vision either but reading is fine under bright light.  I now wear a low power prescription power to make up for the intermediate vision.  I don't understand why my eyes seem less focussed now than before so my vision is not as sharp & clear.  My eyes are dry all the time and get tired easily (perhaps due to all day computer work at office).  Glare/halos/starbursts still exist.  What bothers me most is the flickering light reflections at the upper corner of my right eye whenever I blink under artificial lights.  Do you have the same problems.  I am also told that I have developed mild capsular fibrosis and may need a YAG capsulotomy.

I just try to see if other RLE patients experience as many problems as I have!  Thanks.
CKLG

[cdn_glenn]

I read your "ReZoom & ReStOR lenses" post.  It looks like you have one of each and are considering explantation.  You're considering the Tecnis monofocal lens for replacement.  In my view that's probably wise.  You'll lose near vision (unless you opt for monovision), but that's probably the wisest.  If you try another mutifocal IOL you're in for more of the same issues you've already suffered through.

To answer your question on my IOLs, they're Tecnis ZM900 multifocals.  I had them implanted in November 2006.  It's a year and a half later and I've adapted to them well, but from reading other posts on this forum I think I'm very lucky.  Here's my post made shortly after that time (it's in the old archive and doesn't show posters' names correctly):

http://www.medhelp.org/posts/show/372932?post_id=post_2207749

Here's the spec sheet (PDF):

http://www.neomed.cz/docs/mikrochirurgie-oka/tecnis_mf.pdf

It's interesting that the Tecnis multifocal uses only one strategy ... 32 diffractive rings going to the edge of the 6 mm optic.  Whereas, ReZoom and ReSTOR use multiple strategies.  End result: the Tecnis multifocal works well in most light conditions.  I can read by candlelight and in bright sunlight.  Distance vision is spectacular, much better than I could ever see with glasses.  You mentioned having poor intermediate vision.  The Tecnis multifocal is no different.  The zone for mid vision with the Tecnis multifocal is nearer than the ReSTOR.  It goes from about 18" to 48".  Reading a newspaper in that range I can read the titles and bylines, but not the body of the page.  Actually, if I sit and stare for a while I can make things out.  Easier with +1.00 readers.  For the ReSTOR the midrange is a bit farther, making them better for computer use.  I've read much literature on the ReZoom and it seems to promise good mid vision, but sadly many report this isn't true.  Also, ReZoom seems to be highly affected by different light conditions.

Regarding the flickering lights: this happened often after implantation and occasionally still happens.  The trigger is being overly tired or drinking too much coffee.  Only happens with fluorescent lights.

Your capsular fibrosis is certainly affecting your vision.  How much I can't say.  Multifocal IOLs seem to be affected by any irregularity in vision.  It looks like you have a good rapport with your surgeon.  Keep following-up with him.

Good luck,
Glenn

[CKLG]

Thank you, Glenn, for your reply. You have the Tecnis multifocal lenses so I guess they work different from the ReStor & ReZoom.  I don't plan to have my lenses explanted since I am very afraid of all the significant risks involved from infection to retinal detachment (though many times I do want to when I am frustrated by the agony caused by these lenses).  I can't believe my cataract surgeries could go so wrong and I am a healthy 50 years old!  
(1) I don't know why the ReZoom lens is not giving me the "claimed' intermediate vision.  
(2) I don't know why after 6-months post-op my distant vision is not as sharp & focussed as before.
(3) I don't understand why as soon as I am indoor I am having spotty misty vision & seeing ghosting with my ReZoom lens.
(3) I don't understand why after 6 months my glare/halos doesn't diminish a bit
(4) I don't understand what causes the most annoying flickering light reflections in the right side of the ReZoom lens when I blink under certain angle of any artifical lights - even in a room when facing a window!  Is this a reflection of the lens itself?  Will it go away or is permanent?
(5) I don't understand why having this flickering light reflections for a while (such as sitting in a bus with all the neon lights above) will give my eye pressure & discomfort.
(6) I don't know why I am seeing floaters since February - is it because my eyes are strained & I am too stressful?  
(7) I don't understand why I have developed capsular fibrosis so soon when my eyes were healthy and never had any problems except the initial stage of cataract before surgery.

It's all my eye surgeon's idea to send me to see an eye specialist on April 17 to discuss the possibility of having my existing lenses explanted and replaced them with the Tecnis monofocal lenses.  He suggested monovision but I know it won't work as I tried monovision contact lenses before and it drove me nuts and gave me headaches.  I wore bifocal contact lenses before my surgery.  I am very depressed and don't know how I am going to live the rest of my life if my eye condition doesn't improve.  

Sorry that you have to listen to my whining.  I just have no way out and am very frustrated and worried.
Thanks for reading my email.
CKLG

[CKLG]

Dr. Kutryb, I have read your replies to other patients and found them very thorough.  I have ReZoom in my right eye & ReSTor in my left implanted last October (sole decision made by my eye surgeon).  I am having many disappointments and complications as you can read from my post above.  Since my eye surgeon is not friendly or helpful and it takes a long waiting period for setting up an appointment, would you be able to answer some of my questions & concerns:
1) I don't know why the ReZoom lens is not giving me the "claimed' intermediate vision.  
(2) I don't know why after 6-months post-op my distant vision is not as sharp & focussed as before (both lenses).
(3) I don't understand why as soon as I am indoor I am having spotty misty vision & seeing ghosting with my ReZoom lens.
(3) I don't understand why after 6 months my glare/halos doesn't diminish a bit
(4) I don't understand what causes the most annoying flickering light reflections in the right side of the ReZoom lens when I blink under certain angle of any artifical lights - even in a room when facing a window!  Is this a reflection of the lens itself?  Will it go away or is it permanent (which means I am doomed for life!!!)?
(5) I don't understand why having this flickering light reflections for a while (such as sitting in a bus with all the neon lights above) will give my eye pressure & discomfort (I would even use the word pain & side headache).
(6) I don't know why I am seeing floaters since February - is it because my eyes are strained, traumatized & I am too stressful?  
(7) I don't understand why I have developed capsular fibrosis so soon when my eyes were healthy and never had any problems except the initial stage of cataract before surgery.

My eye surgeon suggested I have my existing lenses explanted and replaced with the Tecnis monofocal lenses.  I am extremely nervous and afraid of the significant risks involved (and given my luck with the first surgery!).  He also suggested a YAG capsulotomy for my capsulor fibrosis if I choose not to have my lenses explanted.  But there are risks involved with this treatment, too, such as RETINA DETACHMENT, right? How long can the capsule bag hold a lens if it has a hole in it????

Sorry for this long email but I am very depressed and desperate with my eye condition.  Thanks for your patience and look forward to your reply.
CKLG