cateract sugery questions piggyback multifocal IOL

Hello all,

I posted once here a long time ago looking for answers.  Due to my bad vision it's hard to navigate around looking for answers.

My eyes has always been bad since I was young.  It is of unusal egg or football shape and large, succeptable to retinal detachment.  I have had lasering done when I was young for retinal thinning.

My current situation is, I have cateract and my vision is going down the drain fast.

I am 36 years old
My eyes was around -12 and -13 before...recently as bad as -23
I see double vision, glaring, bluriness
It's just hard to function these days.

I am having the surgery very soon, within 3 weeks.  I will meet with a retinal specialist this week and final measurment next week.

I have some questions before I ask my eye surgeon more questions.

I've decided to go with the multifocal IOL, ResTor and ReZoom

On top of that, due to the high myopic nature of my eyes, it would have to be piggyback on a monofocal IOL

My eye surgeon seem to be very confident that I would not have any problems with the fact that I have 4 lens stuck in my eyes.  He is one of the top 10 in the nation and graduated #1 at Baylor College of Medicine, conservative in his practice, but recommend I go with restor and rezoom.  So I have confidence in his abilities.  Still I am worried about it, afterall, these are the only two eyes I have.  He recommend that I do the surgery 1 week apart for each eye since I might have a problem functioning with eye.  To me it doesn't matter as long as I know the first one went successfuly without complication.

1.  I would like to know from people who have had multifocal IOL, how well do you see out of them and if you experience any problems.

2.  To any eye specialist out there, will I experience more problems with piggyback multifocal IOL, what about intraocular lenticular opacification and how worried should I be about this?  

3.  I am only 36 years old, will the lens last my lifetime

4.  I'm afraid to ask if there's any pain involved, if I had it my way I want to be completely out cold.

5.  Due to having 4 lens, will there be a weight problem, will it sag in the future and cause some problem, will I see the edge of the lens?  

6.  Before surgery, is there any type of food I should eat or avoid to lessen the chance of infection/complication?  What should my diet be before the surgery.  

[Joan M Pernoud, MD]

Lens implants are very light so that is not a problem.

The possibility of lens glare is a problem you must know that very few surgeons have alot of experience with eyes where they place 2 lenses as a planned procedure in two eyes routinely.  It is unlikely the lenses would opacify but I am more concerned about the possibility of the lenses rubbing against the eye tissues internally causing inflammation, glaucoma, or bleeding in the eye at some point.

With an eye prone to retinal problems because of the great myopia, I would just get a single lens implant in my eye placed in the "bag" which is where the lens does not touch vascular tissue. If you need additional retinal work, it could be difficult for a retinal specialist to work trying to see around the edges of 2 lenses. I would get a regular non-multifocal lens as you have enough interesting things going on without adding another potential glitch as some people don't like their multifocals for various reasons. You would need reading glasses but that is a small price to pay for the best possible vision in my opinion.

Pain during surgery is hardly ever an issue as the surgeon will numb the area in a way that works weel for his or her patients. An IV sedative will cause relaxation. No problem there.

Good nutritious food is good and maybe a good multivitamin every day.

Make sure your hygiene is good leading up to surgery so there are no unusual germs lurking about.

The questions you are asking are very good and if you had 10 good ophthalmologists to ask you may get almost 10 opinions about what you should do. I think you should get several more opinions and ask all of them these questions and see how you feel then.
I do not wish to be contrary but just think you should give this careful thought as there are pros and cons involved in this decision.                Good Luck!

[JodieJ]

Dr. Pernoud has given you excellent advice.  At the upper right corner of your monitor you will find a little rectangle that says "Search Med Help."  If you type in words such as "ReZoom" or "ReStor," you will pull up links to past threads about these multifocal IOLs.  Many people have had terrible problems with these lenses (especially with ReZoom).  I think that they are a very poor choice for people with a history of retinal problems (like you and me); it's like asking for trouble.  Please consider getting another opinion before proceeding.

[JodieJ]

I apologize in advance for being such a "spoiler," but your post concerns me.  You described your eye as having a football shape, suggesting that you have significant astigmatism.  Multifocal IOLs do not correct astigmatism, which causes problems with ghosting, halos and blurred vision.  The ReStor IOL in particular is reported to be extremely sensitive to even minimal astigmatism.  Be sure to ask your cataract surgeon how this issue will be addressed in your case.  It would also be an excellent idea to ask your retinal specialist whether the presence of a piggyback IOL would create problems visualizing your retina in the event that you require retinal surgery in the future.

Best wishes.