Tecnis lens problems after cataract surgery

[Cmesinger]

Had cataract surgery done on my right eye January 16 and the left eye (dominate eye) done on January 30th 2014. Had the tecnis ZMB00 lens put in both eyes. Have good close up vision that starts getting blurry at about 18 " to about  8 - 10 feet and then it is clear until forever. My problem is that I need my intermediate vision for just about everything I do. I can see everything but it is fuzzy and I can't read anything at 18" until 8'. It is very frustrating not to be able to function like I did before surgery. My doctor says that he can tweak my vision but I will have to give up something. I told him I will give up some of my distance but how will I know how much I will be giving up. He said that was hard to tell.  I also see halos and lots of glare during the day as well as at night. My vision is jumpy too when reading or looking at objects in that mid range.
Has anyone had this problem and had it tweaked to correct. Wondering how to communicate with my doctor so that I get the correction that I need. Thanks

[Cmesinger]

That's good to know. some of my halos at night are becoming less star like and more translucent and smaller. I'm taking that as a good sign. During the day high contrast lettering on signs and TV have much ghosting around them. Store lights and LED lights are the hardest for me.
Nice to hear from someone who understands what is happening but also gives me hope for resolution of these problems.
Once again thank you for your time!

[cdn_glenn]

During the day there weren't too many issues.  Store signs where the lettering was something high contrast came up double.  This cleared after many months.

At night the halos were very, very noticeable.  The halos around lights tended to be large and opaque.  After a few months the halo size reduced and started to become clear.  It's been many years for me and, while not totally gone, I don't really notice them.

[Cmesinger]

Thanks for your response. You have helped me understand why my vision is like it is. Did you out have problems with halos and glare during the day. Nighttime glare is still pretty bad but I  knew that was a possibility going in. Thanks again for taking time to respond to my question.

[cdn_glenn]

Hi CM, I had Tecnis Multifocal IOLs implanted several years ago.  I'll do my best to translate the specs.

The +22.5 and +23.5 are the lens prescription.  It's on a different scale than glasses, so I'm not sure what it would compare to for regular glasses.

The +4D is the add between your prescription and your near lens.  Four dioptres is a lot of gain.  Most manufactures settled on a +3D add, which gave adequate near vision while keeping the mid-vision area workable.  The advantage with the +4D add is that near vision usually ends up being crystal clear.  I can do very detailed close work and can see everything clearly.  The disadvantage is that it causes a fairly sizeable area of poor mid-vision.  In my case that ranges from about 18" to 4 feet.  Past that vision is very good again.  You are only about a month into the healing process and I hope your mid-vision numbers improve.

I may be wrong, but I think the T:13mm is the diameter of the IOL including haptics -- the arms that steady the IOL lens in the capsule.

6mm is definitely the diameter of the IOL lens itself.

I had my Tecnis IOLs implanted seven years ago.  They are really bifocal in design.  At the time I was satisfied they were one of the better multifocal IOLs available.  It is interesting that there are now a couple of trifocal IOLs available on the market, and from initial response on this board it seems they are doing reasonably well to cover mid-vision.

[Cmesinger]

Also where would I find the residual refractive error? I have a card they gave me with this information on.
Left eye. Diopter +22.5+4D.    t:13mm.  B: 6mm.    2017-9
Right eye. +23.5D+4D.              13mm.       6mm

I have not a clue what this all means but this is all I know.
Thank you so much for your time. I am not at a panic just a bit frustrated.

[Cmesinger]

Oh now I realize what plus one reader is. Thanks

[Ray T Oyakawa, MD]

Each presbyopia correcting IOL has it pluses and minuses.  The Tecnis has excellent distance and near (nearer than many people like) and poor intermediate.  None of the presbyopia correcting IOLs give a complete range of vision.  I would wait 5 to 6 months before doing anything. Are your numbers good (residual refractive error)?  Use +1.00 reader for intermediate.  The intermediate vision tends to get better with time.

Dr. O.