original restor lenses, now with posterior vitreous dissection

I am a 55 year old anesthesiologist, and had the original Restor lenses placed in june 2008. My intermediate vision never recovered. I lose my clear vision between 14 to 34 inches. It has been a struggle to do my usual activities, ie read chart fine print, iv's, drug labels,intubate, etc. Magnifier glasses have not worked because I lose the clear visual fields I do have. My job requires me to quickly be able to focus at different distances without playing with reading glasses. I have tried several prescriptions with no success. A few months ago the vision got even worse, a greasy cotton ball like structure in my eye, makes everything even blurrier, especially in bright OR light conditions. Unable to read the small print on computer generated charts which are at a fixed distance from where I stand. Looking at brightly lit screens is difficult. I went to a retinal specialist who said I have a posterior vitreous detachment, and it is causing the increase in visual problems because the multifocal lens are magnifying the effect. This is complicated by dry eye, and the presence of a pigmented lesion on my retina which we are watching for change. I have several questions:

How do multifocal lenses magnify the effect of a vitreous detachment?

I see many posts about the poor intermediate vision with the original restor lens, but I cannot find a specific web site of actual information or testing. Is there a site that explains this, and is my blurry vision of 14-36 inches the norm for that lens?

What would be the risks of replacing my lenses and repairing the dissection? Would it again be a 'wait it out' scenario for a year or more until I adapt to them?
Would replacing with newer technology lenses decrease the halos at night, the glare from screens in the OR, and give me workable vision at all ranges, or is it worth the risk? I am trying to decide if I should do all of the necessary surgery, or just live with what I have and change my job.

[Houman Vosoghi, MD]

1) they don't magnify it but if it blocks the central ring for distance vision, it may seem like that vision is blocked more so than with a standard distance only lens.

2).yes frequent complaint.  Run some google searches and some blogs come on.  Also, read the posts on this site re multifocal lenses.

3). Risk too high in my opinion.  Just get a pair of intermediate glasses for when you need it.  Your vision needs should have been considered more carefully before choosing a lens.

4). Don't change your job.  You should be able to get by as above.
HV

[cwatt1]

The "greasy cotton ball" effect may be due to posterior capsular opacification.  This can happen when cells grow and attach to the back surface of the capsular bag.  years after your original surgery.  It sometimes occurs years after cataract surgery.  If this is indeed the case, it can easily be rectified by a YAG laser procedure which essentially creates a hole in the back of the capsular bag.  It can generally be done in the ophthalmologist's office, requires no recovery time, and takes only a minute or so.

[Houman Vosoghi, MD]

Rereading your post it seems that you have already tried intermediate glasses but can't afford to loose the other distances.  You may want to consider a pair of bifocals or tri-focals or progressives with clear glass for distance to see if you could switch between the different tasks your job requires.  I don't have much experience perscribing such glasses for multifocal lenses but it may be worth a shot to avoid the risks of surgery.  If all these attempts fail to allow you to do your job adequately, you may need to consider lens exchange.  But the risks are high.

HV

[bbbiker]

Thanks for the replies. I did try intermediate glasses and lost too much of other distance. I tried progressives early after surgery and had trouble getting used to them, but it may be worth revisiting them now. I would like to avoid surgery if possible. Thank you for your input on the risk being high. I am going to hold off on lens exchange as the last option. I do have some posterior capsule opacification, but apparently was not yet bad enough to do yag laser on. I am going to find out at my next appt. if the central ring is blocked. General sense of visual acuity has been worse since the vitreous detachment, but it may be that I didn't have a lot of reserve in the intermediate range, and something minor is making it seem much worse.

[madi_love]

hi sir i am madi 4m lucknow i say that my mother eyes prob. And to much pain

[londonbridge]

I had restor lens exchange which was successful. I wear transition lenses for reading difficult at first to adapt to. IMPORTANT - If you do the yag first exchange will be extremely difficult do to hole in capsule. Seek a top surgeon if you do an exchange. I went to MEEI in Boston