multifocal lens dissatisfaction, considering replacement

[travelernps]

6 weeks ago I had a restor multifocal lens cataract surgery on my right (non-dominant ) eye.It improved my close up vision but my distance vision is completely blurry and totally out of focus at ALL times. I had no trouble with any distance vision in either eye prior to the implant . I was only using reading glasses. I am also experiencing extreme halos and starbursts at night with the implant eye along with flickering in rooms with florescent lights. At the 3 week post op visit , my surgeon ran all the tests and ruled out everything and basically said my outcome was very rare. I might add that he is considered one of the top surgeons in my area. He suggested that I do my left eye with a mono for distance and see if I could adjust and be happy with the multi in the right eye...and if not he has no problem replacing the multifocal eye with a mono for distance to match the left. I have since received 2 more opinions from leading ophthalmologist. They both ran all the tests and stated that the lens was perfectly centered, pressure and everything else etc. is fine. One suggesting a weaker strength multi for the left eye and leave right one alone. The other dr said he wouldn't touch the left eye until I corrected the right eye and said to give Restasis a try . The original dr said that he did not think I had dry eye because my vision was constantly blurry not only at certain times. It is my understanding from the opinions of the 2nd and 3rd doctor that time is of the essence for removing this multifocal lens. One even said weeks not months and the other said 3 months would be his limit. I am totally confused and would love to hear from anyone with similar   situations. And of course, would so appreciate any ideas and/or opinions from an ophthalmologist.
Thanks so much.    

[JohnHaganMD]

You omit some extremely important information and that is what is your distance and near uncorrected visual acuity in the RE and what is the best corrected vision and the refraction.  Without that information I can't respond. Hopefully your near vision without glasses is good (J1 or 20/20) and your distance vision not too bad say 20/60 and comes up to 20/20 with a RX like -1.00   That would mean you are dealing with a healthy eye and the problem is just the IOL power.  If it was a dry eye the distance vision would be much better after blinking or after instilling artificial tears. In any case need the information.

[travelernps]

yay ! I was hoping you would respond. I have read MANY of your informative articles, blogs and responses. So thanks for taking the time. I don't know the numbers that you are asking for but could probably get them soon. My near vision in the multi lens right eye is not quite good enough by itself . I still need my reading glasses that I was using prior to surgery,to read a book or articles on iphone etc. so as a result it makes reading blurry out of my RE. My distance in my left eye is very good.. clear and in focus unlike the RE. I had great vision before the cataract surgery in both eyes. Just needed reading glasses.  So yes, my right eye seems to be healthy except now I can't see things clearly far off. And, you are right about the dry eye theory. I have been using a lot of artificial tears and omega 3 supplements to see if that would help. It  has not.
thanks

[JohnHaganMD]

I have to ask the obvious. If before you cataract surgery "I had great vision before cataract surgery in both eyes" why in the world did you have cataract surgery?

[JohnHaganMD]

And if your vision is good in your LE why are you even considering having it done?

[travelernps]

Great questions! By great vision I meant that I could see fine without any need for glasses for distance for my entire life (64 yrs. old )  But was noticing halos at night and some beginnings of difficulties seeing small writing like the ticker tape at bottom of TV  and reading street signs in the distance. And was told about my cataracts about a year ago and then that they were worse 6 months ago. I understood that cataracts did not improve or go away so that is when I went searching for a Dr with great credentials and lots of experience to perform the surgery. I certainly will not be doing anything with my left eye any time soon. I just wanted to express what the different opinions were for me from the 3 doctors. Thanks so much.

[JohnHaganMD]

Okay so you need to find out if your RE can see well with glasses. So get those numbers. If you see will with glasses then its not a medical problem but an IOL power problem. If you don't see well with glasses out of the RE you have a problem.

[travelernps]

I picked up a copy of my records and if I'm reading this correctly my RE(OD) under visual acuities is 20/30-2 for distance and 20/40 -2 for near.  
and under refraction it's 20/25 distance.
I sure hope this helps. Thanks!

[JohnHaganMD]

What are the numbers for the glasses testing e.g. -1.00 sphere

Do you have any other eye diseases that would keep you from seeing 20/20?

[travelernps]

I'm not sure where to find these numbers for testing with glasses. I only had my reading glasses of 2.5 strength with me. which when they are on I can read close up fine in left eye but they are too strong to use with my RE with the multi focal lens in. I'm not sure why I am not seeing 20/20, except with the cataract in my LE it's hard to see the lower lines and now with the lens in my RE, I am able to read the letters but EVERYTHING  is out of focus at a distance.
Thank you so much for your help!

[JohnHaganMD]

You know I can't take this much further. I suggest you get a macular OCT to be sure you don't have macular edema. Ask for the glasses RX, ask your surgeon why you are not seeing 20/20 with an over-refraction.  Don't feel bashful about saying you are not happy about the situation. If you are happy with the ophthalmologists that did 2nd opinions you can return to them. Don't do anything to other  eye till you work this one out

[travelernps]

I really appreciate your staying with me on this. I've read hours and hours on this blog and your website reports. so, I can't tell you how highly I think of you and the time and expertise that you devote to the many of us confused patients out there.

My glasses RX before surgery is 20/30 in both with the RE needing a little stronger RX. I'm assuming  that the reason it's not 20/20 is due to the cataracts.
When I expressed at the 3 week follow up the fact that everything was blurry in the distance but I could see much better up close, my surgeon ran all the tests over again including a macular OCT and said everything was normal and that what I had was "rare".
also, at my 3rd surgeon opinion  visit they ran a macular OCT and the findings are listed as : WNL OU  (which I  assume means within normal limits )

I definitely will not do anything to my left eye any time soon even though both 2nd and 3rd opinions both list the LE with moderate cataracts. But when I do get ready I do not think I could ever put a multi focal in again.

I'm leaning towards having my lens explanted with a mono for distance.
What do you think ? How will they determine the distance strength with a multi lens already in place ? And could you please  tell me your thoughts on the risks of this surgery. I would still go back to the original surgeon as he is considered the top surgeon at this highly respected facility here in the southeast. I feel sure you would agree if I mentioned the facility.
Thank you so much for your valued opinions!

[JohnHaganMD]

Okay I'm making the assumption that at one time in your life that with or without glasses both eyes could be corrected to 20/20. IS THAT TRUE? If not then what was the reason?  Did you have an amblyopic eye. Assuming you were able to see 20/20 before surgery and the only problem you have is the IOL power an over-refraction should be able to convert your RE to seeing 20/20 distance and near. You have said that is NOT the case and the best you can be made to see with glasses is 20/25 hense the question for you to be answered why not 20/20? They will probably use your original testing. So my biggest concern is why can't you see 20/20 with a normal macula and an over-refraction.

[travelernps]

I'm pretty sure that my vision was 20/20 before surgery. I don't have those records. The information I got today was from the call back tech with my Glasses RX being 20/30. This was from a dr visit back in Nov. with my regular eye dr. ( not the surgeon )
I have never been told I have an amblyopic eye.

Could you please explain your statement -  "and the only problem you have is the IOL power an over-refraction should be able to convert your RE to seeing 20/20 distance and near. " - are you referring to the type of mono for distance that would be put in ?  I'm sorry I don't understand many of these terms because  in the past I have never had to pay attention or be concerned  with  any numbers as I was only needing over the counter reading glasses.  

Could it be a possibility that the measurement to determine the strength for my RE ReStor  multi lens was faulty/incorrect  ? Does that ever happen? If so, how would I ever get a correct strength for a mono to replace the multi with ?
And then lastly, would laser correction on the multi lens be a better less risky option for me.. knowing that I probably would not be able to have a lens extraction after the laser was done.

Thank you again so very much !

[JohnHaganMD]

No the measurements are not the cause of your vision not being 20/20.  This is the problem as simple as I can make it. When they do a glasses test NOW they should be able to get you to 20/20 but they can't the best they can make you see is 20/25. You have had several doctors look in your eye and had a macular OCT and things look normal. the problem may be the ReStor IOL itself as it has been associated with "waxy vision"  follow this link:  http://iovs.arvojournals.org/article.aspx?articleid=2385830    You likely are going to need an IOL exchange. Our practice has not used ReStor or ReZoom IOLs.

[travelernps]

Thanks once again for your attention to my concerns.and thanks for the link to the article. I read it .. very interesting ..for what I could understand. I would love to see more recent data on the restor explantation.
So, in your research have you found that this waxy vision and halos  clear up when the multi is replaced with a mono ? And are the majority of patients pleased after a multi explantation ?
Thank you !

[JohnHaganMD]

I'm not doing research. We don't use those IOLs so we don't have that problem.  All you have to do is an internet search on complications with ReStor IOLs.   It's reported that removing the ReStor and replacing it with a different kind of IOL usually a monofocal takes care of the problem.