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Tecnis Issues
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Tecnis Issues

I had the tecnis multifocal lens implanted in both eyes after cataract surgery a little over a year ago and I'm not happy with the results. I have huge halos around points of lights at night with concentric rings around the halos. I also have no intermediate distance focus. Also I have halos around white and silver objects during the day. My eye doctor implies that I'm too picky. I'm hesitant to ask for an exchange to a mono focal because I don't want to make things worse and my eye doctor does not want me to do an exchange because he says I could have the same issues with a mono focal lens. Can anyone give me a good rule of thumb to go by in having the lenses changed to Mormon focal to improve vision?  I really dislike my current vision but I'm not sure how to proceed from here.

Thank you

Steve
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711220_tn?1251894727
I would get a few second opinions.  Make sure you do not have residual refractive error or other problems before an IOL exchange.

Dr. O.
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Dr. O

Thank you for your response. I will do that. My eyes do test at 20/20 for near and far using an eye chart. That's why this seems so weird to me to be having these problems and is probably why I get the comments about being too picky but I wish there was a way to show the doctors what I see through these lenses.

Also I've found out from one doctor that when I use Pilocarpine eye drops it improves my vision because it shrinks the size of my pupils. Is this an evidence of something to you? This came about because I told the doctor that when on coming head lights at night hits my face my vision improves so he asked me to try the drops. When I use the drops my halos are reduced and I can finally see my dash board controls.  Have you heard of this before?



Steve
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Avatar_m_tn
It sounds like the Tecnis multifocals are doing what they're supposed to do: good near and good distance vision.  They don't at all have good middle vision, but there are ways to deal with it.

I've had Tecnis multifocals for the past five years, and neuroadapation was much slower than the six-to-eight months promised.  Part of dealing with multifocals is learning how to live with them.  For middle vision you need to get a pair of +1.00 readers.  This bumps the middle vision to a place where everything is back in focus.  I often use them while surfing the Internet because I'm leaning back in my chair, working the mouse.  If you were near sighted like me you will already have most of your desk area set for near.  I really don't have an issue when working at close distance.  Also, if you were near sighted like me you will appreciate still being able to do this.

Regardless of what has been said about the Tecnis multifocals being pupil independent, they do -- initially -- have issues in low light.  I found this did improve.  For example, can you see the dashboard better when driving in daylight.  Initially both day and night were poor.  Now day is good and nighttime is 'not bad'.

Hopefully in time some of the issues will resolve.  After a year the changes are very slow.  I was occasionally surprised to notice an improvement on something like reading the shelf prices in the store at a reasonable distance.

Good luck whichever decision you make,
Glenn
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Avatar_f_tn
Glenn,

I appreciate your comments.

My middle vision works outdoors but not at all indoors. Even under bright light. Also everything looks so grainy to me indoors. Do ( or did) you have an issue with halos? I have huge halos at night and even during the day. When I read, letters on a page look hazy because of halos. I have used reading glasses for computer work and they work fine for things about 2 feet away, but the things further out are then very blurry. Indoors everything from 2 -6 feet out is out of focus. The increased halos indoors makes a lot look out of focus.

Steve
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Avatar_m_tn
Hi Steve,

I found after a while, more like a year and a half, the middle vision started working better indoors.  I didn't need to lean in or step back to read the prices on store shelves.  Sadly those milestones are few and much too long waited.

Regarding the grainy look indoors I'm a bit stumped on that.  Not part of my experience.

Halos?  Yep, lots of them at first.  Used to try to count the rings around a street lamp.  One time I got 34 -- there's only 32 rings on the IOL though.  :)  After about six months the halos around near lights decreased and only the distant ones had multiples of rings.

Also I found the way I looked through the IOL made a difference on how many rings I saw.  I don't know if this is all that scientific, but I just found: looking ever-so-slightly off centre through the lens and the number of halos diminished.  It became reflex after some time.  And the big issue -- like for counting the rings above -- was that I was looking directly at the lights.  I later got in the habit of looking between the lights instead of straight at them.

I'm thinking the hazy text you're reading are more likely ghosts, a second image of the same text.  My ghost images are at 6:30 and 7:00 when I see them.  (Pretty accurate IOL installation I think.)  Perhaps adjusting the light, possibly dimmer or less direct would help.  With ghosting I would notice it every day on my walk home.  All the shop signs with high contrast used to show up double.  It's five years later.  I've actively looked for ghosts and can still see them, but they are now quite minor.  And a cloudy day used to be much better for vision without ghosts.  Now sunny days are great too.  (Still it was five years.)

Regarding the near / middle / distance ranges, I've actually measured:
Near is 8" to 18", Middle goes on to about four feet (depending on light), and after that distance is great!  Initially these measures, which never changed, were quite firm.  Now there's a bit of latitude where I won't be reaching for a pair of reading glasses.

Lastly, for middle vision, I often saw ghosting / double image of computer screen text.  I absolutely had to put on glasses to see properly.  I'm guessing my brain was seeing both near and far images focused on my retina and showed me both.  Now I just see one out of focus image.  If I could have just told my brain to pick one because neither image would be in focus without glasses...?

Cheers,
Glenn
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Avatar_n_tn
Glenn,

It's now been over a year and a half now and I'm still trying to get use to these lenses. Sometimes I wish I would have just gone with the mono-focals. First the good part, I believe I have outstanding near focus. I can count the hairs on the back of an ant with these lenses. Without glasses I can read extremely fine print as long as it's under good light.  But I feel like I'm paying a high price for this privilege. Halos are still huge, especially with those new LED lights. I get these razor thin rings radiating outside and beyond the halos.  When cars that are a little ways out hit their brakes the halos are bigger than the car. I tried looking between the halos like you suggested but it has no effect with me. I'm also still getting major halos during the day. Almost everything has a halo in the sun, especially if it's white.  I'm starting to wonder that since I have to wear glasses anyway to read the computer monitor why not go with mono-focals, wear glasses to read and get rid of the huge halos. I can see fine print but if I move just a few inches either direction in or out I lose focus. Indoors middle distance is still very out of focus no matter how bright the light it is under. If I wear 1.00 readers to see intermediate distances at 2 feet out, the things at 3 feet are out of focus.

I know what you are saying about pupil size being a factor.  At night I can't read any of my dash controls but I noticed that when oncoming headlights hit my face the dash came more in focus and halos diminished.  One doctor that I saw for a second opinion gave me eye drops for glaucoma to try because the side effect causes smaller pupils. After I took the drops the halos reduced by 80% and I could read the dash at night. I didn't like the idea of having to take eye drops to see clearly, plus the drops burned like crazy. I had to take the drops 3 times a day to maintain the effect so I stopped taking the drops.

I'm still in a quandary about what to do. I hate these halos and lack of intermediate distance vision. I would gladly wear glasses to read if it got rid of the halos. Indoors my general vision is poor unless things are near or far an under bright light. My original doctor said that he can't guarantee the focus I get outside will be as good if I have a lens exchange.
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Avatar_n_tn
If anyone reading this is considering a multifocal lens keep these things in mind. For some they work great, for some not at all, and for others like myself some where inbetween. This is my idea - if you are the type who wants the clearest vision possible and details in your vision are important to you go with the mono focal. If the idea off not having to wear glasses is important and you can put up with some abnormalities with your vision for the sake of not wearing glasses then you might be a candidate for multifocals. Just keep in mind what a friend told me and I did not listen - statistics can show that on a multifocal lens that it works  well with 85% of the people but if you fall into the 15% that it doesn't work well it's 100% bad for you. When my friend told me this I thought he was overreacting until I started to live it myself. Its been a rough year and a half. At first just driving at night was a huge challenge, today I can do it more easily but I hate the halos. I'm the same person who started this thread (Road_Glide_Steve) but I'm hoping I find the answer that is right or me - either I do exchange these for mono focals or I can adapt and my vision improves.

When this all started I had a cataract in my right eye that was affecting my vision and one in my left that was not. My left eye is my dominant eye and sight was still very clear with my glasses on. I had read that multifocal lenses do not work well in just one eye so I had both done - plus my eye doctor told me I was a good candidate fir the lens and if he had to have cataract surgery th Tecnis multifocal would be his hoice. The vision quality in my left good eye (with glasses) after the tecnis multifocal inplant  is so much worse than it was with glasses so I went backwards instead of forwards with my overall vision quality. I guess only time will tell if I made the right choice or not.
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