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cataract surgery with monofocal lenses
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cataract surgery with monofocal lenses

Hi Dr. Hagan,

I read with interest on line about patients with myopia/presbyopia who sometimes see all three distances with just monofocal surgery, no adjustments of any kind afterward, no mono or mini vision, etc.  I heard that this sometimes happens, but it is unusual.  Unfortunately, I accidently lost the site as I was reading the article, and couldn't find it again.  The article also said that there are some catract & refractive surgeons who can make this happen with surgery, and also  extensive tests that insurance will not pay for.  Also, stated it was not something talked about too much, because surgery with premium lenses is much more lucrative.  It was on a reputable patient/answer site, and one of the patients wrote that this had happened to her.

Do you know the medical term for this?  If I could only remember that, I would probably be able to find it again.  Thanks, hope you can help.  Just found it to be really interesting subject.

I do not know the name of the site, but I am not aware of a monofocal lens implant which will focus far, intermediate, and near.  I have had patients who can read after a monofocal implant for distance, but there are very few of them.  A crystalens implant will give good far and intermediate vision, but often glasses are needed for prolonged reading.
Hi Dr. Fazio:  I have been having a horrible time since cataract surgery almost two years ago on left eye, and 1 yr. ago on the right eye.  Sometimes I think if it weren't for bad luck, I would have any at all.  Because of problems with the Restor left eye, my 2nd opinion doctor implanted a Nanoflex monofocal lens in my right eye.  I saw beautifully, 20/20 distance, and anything past 18-20 inches away was also good.  Five weeks ago I had to do the Yag, since then I have blurred vision at all distances.  Can the Yag cause this to happen?  Could I really go from 20/20 to about 20/40?  When I place my chin on my chest and look up through the eye everything becomes clear, can read TV captions from 40' away, resume a natural head position and everything becomes blurr again.  Can this lens now be off center, and if so, what can be done now it has had Yag?  Any possible answers for me?  I want to get on with my life, I am so stressed out, I am feeling lethargic, and such poor vision makes me feel like I am constantly seeing in a haze, which I am.  I don't want to buy glasses until we get the Restor eye straightened out.  

Also, my 2nd doctor was going to make a plan for the Restor left eye.  Now he wants me to see a Low Vision Specialist to see if she sees something he missed!!  I don't think he missed anything.  I have bilateral PVS due to accident many years ago, the Restor lens is well centered, off by 1/2 diopter, mild opacification.  Vision might be about 20/30 and awful.  Having a cloudy floater in my line of vision in both eyes does not help.  Trying to learn to live with that.  

Saw a retinal specialist before the 2nd surgery, (Nanoflex).  He said everything looked good.  Eye pressure is good, no signs of macular degeneration, or glaucoma, which I am thankful for.

Was having the Restor lens implant a bad idea because I do have posterior vitreous separation - not perfect eyes.  Corneal astigmatism is mild, and relaxing incision was done with Restor surgery.  I felt that explant and Nanoflex in the eye would be the smart thing to do so that I have 2 same lenses which I would think is more ideal.   Also, my genuine fear is that if I Yag/PRK for better distance, maybe it won't turn out that well.  And the PRK will jeopardize the close up vision, which is already sketchy.  So if I need reading glasses, why did I ever do the premium lens.  Also, look where I am now after Yag in the monofocal lens right eye.

Any advise you can offer me will be so appreciated.  My doctor does not share and so I am always in total "darkness".

I would love to find a good explant surgeon within not too far traveling distance of where I live.  Dr. McKool in Astoria, N.Y. was recommended  as having a great deal of experience with Restor.  He doesn't take insurance - I need a money tree.  Someone posted on MedHelp had two explants with Dr. Kevin Walter in Indianapolis.  Dr. Walter was kind enough to return my call and said I can still have the Restor explanted, but he is so far away.  He knew of no one in my area (Virginia) to recommend.  I can travel to surrounding areas, N.Y. is not a problem.  How can I find a suitable doctor to help me.

Thanks for letting me vent, I know this is long-winded.  Please respond, I do so appreciate any advice you may have.

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John C Hagan III, MD, FACS, FAAOBlank
Discover Vision Centers of Kansas City
Kansas City, MO
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