problem with multifocal lense following cataract surgery

Had multifocal lense put in right eye following cataract removal.  Distance vision is many times worse than pre-surgery. Everything is terribly blurry and doctor said it would not imporve.  What could have gone wrong?

[achillea]

I am so sorry that your outcome was not satisfactory.  In my experience (an excellent result with multifocals), so much--so much--depends on the doctor's careful, thoughtful measurement of the patient's eyes and his evaluation of the very best lens for these conditions--plus taking into account what the patient hopes for.

Also, I really believe that patients considering multifocals must do a great deal of research and inform themselves.  In this area, one size definitely does not fit all, and we have to think about not only what we would like but what is realistically the best bet for us.

I am sure the doctors here (thoughtful people themselves) will have further advice for you about what to do at this point.

[John C Hagan III, MD, FACS, FAAO]

It is ultra important to know whether your vision can be corrected with glasses over the multifocal IOLs. If it corrects normal then the problem is the IOL power and your options might include wearing glasses all the time, refractive surgery or IOL exchange.

If your vision does not correct to normal with glasses then the eye has some sort of pathology and there is no way to tell if it is the IOL or some other part of the eye.

Remember by far the most common reason that an eye does not recover normal vision after cataract surgery is the presence of one or more additional diseases such as age related macular degeneration.

Your best bet if you and your surgeon have not agreed on a cause and a solution is to get a second then a third opinion about the cause and options.

JCH MD

[Marydemp]

Thanks so much for your concern.  I appreciate your response.  Glad your outcome was so good!

[Marydemp]

Thanks so much for your response.  Yes, the vision is correctable with glasses.  The doctor just said the blurriness would not go away. ...something about astigmatism.  I was so shocked, I couldn't think of anything to ask!  No reason for the poor results was offered, but I have an appointment to discuss the surgery implant on the left eye on July 10th.  What questions should I ask to find out why this happened....what went wrong?  I want to be sure it doesn't happen with the other eye.  Can a lens be removed and replaced ?  Yes, I will get a second opinion!  

[RealityEngineer]

Unless you got a toric multfocal lens (which aren't available yet in the US), multifocals don't correct for astigmatism and may not  work well if you have much of it.

If the vision is correctable with glasses the astigmatism likely can also be corrected with LASIK. Some doctors include a LASIK touchup as part of the cost of cataract surgery.

The incision used for cataract surgery can change the shape of the eye and cause "surgically induced astigmatism". Usually with modern lenses they only need a small incision and the induced astigmatism is too small to be a problem, and surgeons plan their cuts to minimize it. However the best laid plans can always go astray and you may have been left with more than usual.

If you had pre-existing astigmatism it seems likely  doctor would have mentioned that beforehand and planned to correct it either using LASIK afterward, or at the same time as the cataract surgery.  Just as an incision can change the shape of the eye in a way that creates astigmatism, an incision elsewhere can reshape it to reduce astigmatism (e.g. a "limbal relaxing incision") . Surgical correction isn't always precise so its also possible for some astigmatism to remain after that (which is why they do  LASIK touchups). They could try correcting your eye surgically now instead of, or in addition to LASIK.

[John C Hagan III, MD, FACS, FAAO]

If your vision is 20/20 with glasses and you have no disease and you are just troubled by that fact you need glasses some or most of the time then its likely your expectations were too high.

Even people happy with multifocal IOLs wear glasses as much as 20-25% of the time.

You can use the search feature and archives and read the many extended discussions about multifocal IOLS.  They do not restore vision like when you were 16, they do not carry guarentees glasses will not be needed after surgery and the complication rate and costs of multifocal IOLS exceed considerably monofocal IOLS.


JCH MD

[Marydemp]

AGAIN, I THANK YOU FOR YOUR INTEREST AND CONCERN.  THE EXPECTAION WAS FOR USING READING GLASSES IN LOW LIGHT SITUATIONS .  I NEVER EXPECTED CHANGE IN MY DISTANCE VISION SO YOU ARE RIGHT...MY EXPECTATIONS WERE TOO GREAT.  WISH I HAD READ YOUR ARTICLE PRIOR TO THE SURGERY.  I HAVE LEARNED!

THANK.

[Marydemp]

THANKS FOR  YOUR HELP.  YOUR COMMENTS WERE VERY HELPFUL.  I HAD NEVER HEARD OF SURGICALLY INDUCED ASTIGMATISM BUT SINCE I HAD NONE AND NOW DO, IT'S POSSIBLE THAT THAT COULD BE THE PROBLEM.  I AM ALSO WONDERING IF THE LENS COULD HAVE MOVED.  THE DAY AFTER SURGERY THE DOCTOR SAID, "PERFECT!  A BULLEYE!" AND A WEEK LATER HE SAID THE BLURRY VISION WOULD NOT CLEAR UP AND "THINGS ARE NEVER ABSOLUTELY PERFECT."  I SHOULD KNOW MORE AFTER MY NEXT VISIT AND YOUR COMMENTS GAVE ME SOME DIRECTION .

[John C Hagan III, MD, FACS, FAAO]

I hope it turns out well for you. JCH MD