explanting Restor IOL, decision help needed

[MsLN]

sparing repeating the details from  my prior posts, regarding dissatisfaction  with Restor multifocal IOLs, my primary problem is loss of quality of  prior (nearsighted) sharp near vision. Now it feels like I'm farsighted, its been about 6 weeks with no improvement. The original Dr said he would discuss changing them if I wanted,  after upcoming  next post-op check  and I believe he is a good surgeon, though he convinced me these lenses would do it all, but that didn't happen. I am going for second opinion  right after that with supposed renowned Dr., if both give same opinion, if my best solution is explanting them,  HOW do I decide, WHAT do I ask, to know , find  and decide who is best choice for explanting these? any helpful input, advice or suggestions would be appreciated

[Liyzng2]

Hi - I have been having the same issue with Restor that you experienced. I wanted to understand if Monofocal now works better for you in the near vision?

[MsLN]

  I changed doctors and had the other Restor removed May 2013. I wanted my near vision so he targeted -2.0 and got  it exactly. The resulting monovision works better than the Restor vision for me and I can function in most tasks without glasses, but have glasses to compensate for distance for driving, watching TV and reading glasses if I'm reading a lot, just to use both eyes more evenly.
From my experience, my opinion is these multifocals may work for a select group with very specific criteria,  but I think it's disgraceful how they seem to be so over recommended  and the non disclosure of all the trade-offs they can cause that are never mentioned by the manufacturer and many doctors.  Sorry to hear you have the same perdicament. Were you also promised these Restor IOls would do more than they actually delivered?

[unhappywithRestor]

I would like to know what is happening to you know. I have had exactly the same problems. I had the surgery on my rigth eye on April 15 and the left eye on April 22.  I hope you are better now. Regards

[JackM829]

It's awful isn't it? My left eye went from -11 to +2.  I had a normal monofocal implanted and while anything at distance, like far distance (30-50 feet) away looks clearer, anything remotely close is like invisible to my left eye.

I'm hopeful that I get a prescription to fix the hyperopia this week.

[MsLN]

I have more followup posts if you can find them. I ended up having one of the lenses exchanged in Dec 2012.  unfortunately the doctor did not target the nearsightedness I asked for (-1.5),  he did -1.00 and it ended up being about 0.0. right now I need readers for everything within arms distance, I am really considering, would like to get rid of the other Restor lens,  as I feel quality of that eye's vision is questionable, even though doctor insists I see better than before, am going to get another opinion about what's going on ,as right now as attentive and accommodating as the original doctor has been and still is, I am second guessing everything he says, but I feel like sometimes my vision has changed a bit and not for the better. hope I have an answer in 2 weeks with new appointment. Don't know if this helps you, but please follow up.

[surpriseoutcome]

If this reaches you, can I find out what you chose to do? I am currently in the same situation, with the same complaints and same options. I have had restor and limbal relaxing incisions for nearsight and astig, 3 mos ago in non-dominant eye. Now suffering with the surprise result of hyperopia and overcorrected astig. I have retreated from life, unable to see, with Anisometropia: The condition in which the two eyes have unequal refractive power. One eye may be myopic (nearsighted) and the other hyperopic (farsighted ).

[MsLN]

thanks again for your kind attention and helpful answers. Out of curiosity, I actually tried a +2 contact in both eyes and the small sacrifice of distance was well worth being able to see everything I need to function in close and intermediate distance, so much more practical. But found my eyes felt tired after wearing contacts all day. Am I correct in assuming if I change to monofocal lenses I will also be rid of the “lesser” side effects of ghosting, halos, flickering and vision will be sharper and not effected by lighting conditions? I will be seeing the original Dr next week to discuss all this and what to do. The sad part is I never should have done this surgery, I lost way more than I gained , so basically I need to go back to nearsighted and glasses and if I retain some better distance that’s a plus.   Just hope  changing lenses doesn’t create any more problems, why Dr thought my vision would be better is beyond my comprehension, and I was so enticed by no more glasses. If prescription indicates this,  I was a -3.00 , so I suppose that further answers why the Restor lenses didn’t work. I believe he truly wants to make this right and his surgical skills are not in question, so I just need to make sure about what decision to make. I will get the records from the extremely thorough exam by the 2nd opinion Dr. Thanks for your input, at least I feel you get “it”, by  understanding the problem I appreciate being able to vent my frustration and anger. I will ask about your suggestion, it sounds logical , hope I can move forward and feel comfortable and enjoy life again, the thought of most likely redoing this surgery as the best option is going to be unnerving until I know I can still see,  & hopefully better

[JodieJ]

I checked, too, but couldn't find the original article I had read.  I did find another paper stating that patients with less than 4 diopters of nearsightedness are poor candidates for ReStor.

Consider mini-monovision with a near vision bias--dominant eye set for intermediate vision, non-dominant eye for near.  If all goes well, you should have excellent uncorrected near and intermediate vision.  You'd still need glasses for driving.

[MsLN]

I think  I found the article, it did reference exactly what you said, being used to my nearsighted with excellent up close vision  for most of 50+ years makes  me the most difficult patient to satisfy. At least 2nd opinion eye exam revealed nothing wrong with surgery skill and lenses from 1st Dr , though he did not properly consider "me" as per the article information.  Given some suggestions  to try before deciding what to do and  then need to decide what vision I would be happiest to try for

[JodieJ]

I read the article I referred to online awhile ago (but where?)  Try googling combinations like "ReStor mildly nearsighted".  You could also try other search engines--it's there someplace.

You may not have been the ideal ReStor patient for other reasons, too.  Having higher order aberrations, larger pupils or residual astigmatism would jeopardize a good outcome.  I completely reject the notion that your dissatisfaction with ReStor has anything to do with your personality.  (This was what was claimed in an earlier post of this thread.)

If two surgeons are both experienced explanting IOLs, it's your choice.

[MsLN]

any possibility of how I can find that article?  In my wildest dreams I would never have imagined my nearsighted -could see tiny details-vision would be so compromised, even being told I'd lose a little and being shown "difference" by letters on eye chart in no way illustrated what I'm experiencing.  Thanks for the information as the Dr said PRK might make a 10% improvement,  probably won't be enough, and to try it and then find I still want  to explant  lenses after doesn't sound like a good idea. Read every post I could find and people seem happier with vision after explanting. (as long as nothing else happens)  Getting 2nd opinion tomorrow, and was told this Dr is extremely thorough and direct,   (aquainted with his office manager through close friend and this made the connection & immediate appointment). I really don't doubt the skill of the first Dr who said he would change the lenses, and is comfortable doing this, sometimes I wonder if my outcome was not what he expected, he has given me a lot of time and attention with this problem, definitely not dismisssing me.  But my feeling is to just change the lenses, especially if the 2nd Dr recommends it. This question may be premature  and difficult to answer but how do I decide who to use? Do I even consider using the original surgeon?(1st Dr is in NY, 2nd is in FL, not that this will effect decision, unless timing and fact that my primary residence and other doctors are in NY)  
again, thanks so much for the feedback, I  finally feel I'm getting some guidance to move forward from this nightmare

[JodieJ]

I agree that you were misled.  I read an article written for cataract surgeons that stated that mildly nearsighted patients (and I assume this includes you) are the LEAST likely to be happy with their ReStor results.  This is because their near vision with ReStors is (at best) not as good as their uncorrected near vision before they had cataract surgery.  This leads me to believe that even after PRK and sufficient healing time, you are still unlikely to be happy with your ReStor vision.  The article went on to state that farsighted patients are most likely to be happy with ReStors, followed by very nearsighted patients.  Maybe your surgeon missed this article.

There's a lot of good info in the archives of this site about explanting ReSors.  You'd want someone who is experienced with this procedure to do it.  Good luck with whatever you decide, and keep us posted.

[MsLN]

yes I'm aware you're not a professional but you obviously are knowledgable somehow or by experience. Sometimes that can be more helpful than a doctor's information.  My bit of initial research revealed nothing of these Restor problems, I found this site and all the negatives afterwards, after much more digging. With my personal  experiences, and eduation in a health profession, I  understand medical terms and explanations to a degree and thought I knew what to ask. I feel misled as to the risks  when these lenses don't work perfectly or nearly so that the more severe side effects were not disclosed or illustrated . There is no way I would have agreed to risk getting  the vision I have now, it is no improvement, it's more of a hindrance than before and certainly quality of life altering, I lost more in practical functioning than  I gained by better distance. The results  the Restor lenses were inferred to deliver were not realized, nor was full disclosure of all side effects and their ramifications. I now feel  for a "qualified" patient their lifestyle and  needs should be  put into the equation, had my personal priorities and  enjoyments been taken into account, this should have indicated I might not be happy with these IOLs, so were my expectations too high? or was I deprived of making a fully informed decision in my own best interests? Thanks for listening

[JodieJ]

You're aware that I am not an eye care professional.  Your last post suggests that you really want more than ReStor can deliver.  I suspect that you would be happiest with some version of (mini) monovision with a near vision bias using monofocal lenses.  This could give you the crisp near/intermediate vision that you're used to.  You'd probably need glasses for some/all distance vision activities.   I suggest that you discuss this option with your surgeon.

[MsLN]

My first issue is what is going to give me clear  near vision, that doen't become so compromised as light conditions change even by a little. Right now   with  such variations in  quality I cannot comfortably do the things I enjoy, Ex-reading , sewing , detailed crafts, I need reading glasses and a close light source or to be by a window. I feel like I am farsighted. Unfortunately,  my vision with the cataract was not yet affected enough to need the surgery just yet, but   it was suggested  the Restor Multifocal IOLs would do it all and ,so why not do the surgery now and benefit from better vision and not needing glasses, except for MAYBE certain  intermediate tasks.  I even asked if I should wait a month until after my son’s wedding, but was assured I would be fine by then and enjoy not needing glasses or contact lenses which no longer gave comfortable vision .(LOL) that was why I needed the contact lens as a temporary fix. I can't believe the mistake I made and compounded it by doing the other eye because of the " will work better that way". The Dr has said he will do whatever I want and will even refund the extra cost, he just wants me to have a happy outcome. Do you have any opinion what may be my best assurance, lens exchange (he says he is comfortable doing this) or can PRK correct the problem. I will also be getting the second   Dr opinion this week, and hope there is an answer. If a choice was possible I would probably rather wear glasses to drive if I had decent near-intermediate vision, enough to see across a room without glasses. can this be achieved? any advice  or insight would be appreciated

[JodieJ]

Unfortunately, any of the options for correcting your vision is going to involve some compromise.  I don't think that it's possible for you to get the crisp near/intermediate vision with ReStors that you used to have with your nearsighted eyes.  However, with some PRK and healing time, I think that you could get acceptable near/intermediate vision.  (You might still need weak readers for some lighting situations, but would that really be so awful?)

Alternatively, you could exchange your ReStors for monofocal IOLS, which you could have set for some version of (mini) monovosion.  But monovision involves compromise, too.  In order to get crisp near vision with monovision, your distance vision would necessarily suffer.

I think that you should discuss your options with your surgeon.  

[MsLN]

clarification-I did not think my near vision would be so compromised
if it helps, I have copy of records for 2nd opinion . Dr has written on chart pseudophakia, suggested lens exchange or refractive prk to fix residual correction

[MsLN]

distance vision is good, no complaints, I think what is happening is  even though I can make out(guess) the eyechart  letters to indicate good close vision, the quality of vision is poor, it feel like I went from nearsighted to farsighted, all near & like up to 4 ft away, vision is blurred, but the brighter the light the clearer it gets, outside in bright daylight  my full range of vision is excellent, then indoors it fluctuates depending on amount of lighting, which also determines which strength of reading glasses, if needed to help, have used from +1 to +2.5 in a dim restaurant and sometimes need extra light too, Dr thinks PRK  may help improve vision. I was told my near vision would not be as good as before when I could work or read without glasses, but not as compromised as it is now. I cannot function comfortably as it currently is. I am going for a second opinion with a renownd Dr (in Florida)  Thank you  both for replying , made me feel someone actually is concerned and maybe will have some specific advice or guidance for me

[cdn_glenn]

Ditto on both Dr. Oyakawa's and JodieJ's opinion regarding waiting.

I've had multifocals (Tecnis, not ReSTOR) for several years and experienced issues similar to yours.  My near vision wasn't great for the first month and I wore +1.00 readers to augment my near vision for the next six months.  After that my eyes had adapted, so the reading glasses were in the way.  My vision has been excellent close-up since then.

The important question is "Can you see well close-up with +1.00 reading glasses?"  If so your eyes are on the way to healing.  Also, you have ReSTOR which are pupil-dependent and you will need additional light to read in low light conditions.  Use the search function to read more.

Again, as Dr. Oyakawa has said you have several months before you need to decide to explant.

[JodieJ]

You stated that a +2 contact lens helps a lot.  This suggests that you're getting little to no near vision with your ReStors.  (Ask your surgeon why.)  How is your distance vision?  Can you read the 20/20 line?  If not, what line can you read?  Could your distance vision be improved with contacts/glasses?

Dr. Oyakawa states (above) that you should give your eyes more time to adapt and heal.  Does your surgeon agree?

[MsLN]

I've read many of your posts, impressed by your knowlegeable , directness, and common sense, so any input into my situation would be much appreciated and welcome, as I'm not sure if everyone, even doctor , who  offered  to do anything to make me satisfied gets what I actually "see"  as opposed to what the measurment numbers from  the  eye chart tests  indicate. he just spent so much time talking with me, his office got so backed up, I feel he is a bit perplexed as what to do for me to get me an  outcome  I will be happy with. I am going for a second opinion, but if answers are same, I would  absolutely trust him if another procedure is needed.

[MsLN]

Dr is willing to do whatever I want, I don't know what the answer is, other than I don't think I can be happy without better quality and consistancy  in near vision, but I'd prefer not going back to needing glasses. For a specific reason I needed a temporary fix and by my request was given a +2 contact lense for my nondominant eye, it really seems to help, my close to intermediate vision ,and I mean  up to quite a few feet away, is much better and I feel better able to  function.  The constant ghosting effect may have even been diminished a bit, what is the likelyhood that this effect will  go away? Does all this indicate anything, such as what to do about the Restor lenses?  very confused about all this, should I  give it more time and patience, is the suggested PRK laser to further correct vision the answer or change the lenses and if so to what?  ?????  

[JodieJ]

I disagree with the idea of a "Restor personality", which was popular among surgeons when this IOL was first introduced.  In my (unprofessional) opinion, this is just a way to blame the patient for a poor outcome.  It seems to me that physical factors such as the presence of higher order aberrations and larger pupils are more relevant.  Mr. Joseph, are you an Alcon employee by any chance?

[MsLN]

I don't know the numbers, the corrections I believe are good. But my problem is even though I can make out to read small print on eyechart to indicate good vision, everything has a ghosting and slight out of focus look.  It's not the sharp close up vision that I had even without glasses when nearsighted prior to surgery and this becomes uncomfortable for any close up tasks. What I don't like is that my overall vision blurriness gets worse as lighting changes, only in bright daylight do I have a full range of sharp clear vision. Indoors the quality of vision varies greatly depending on amount of light, I am constantly switching reading glasses in different strenghts and/or need to add a direct light source to create sharper vision to do things., otherwise close up to a few feet out vision has blurry quality that is very disconcerting to me. Does near vision improve with time, or is it me unable to adjust to the changed vision. PRK was suggested as a possible help to consider,. or is it the nature of the Restor multifocals that cause my vision quality to vary so much with lighting conditions. this inconsistancy is making it very difficult. I hope this explains my dilemma.