rate of visual improvement with IOL implants

[myopic2008]

I have had a Tecnis ZM900 implanted in my none dominant left  eye 4 days ago and am due to have the second implant in 6 days time. I have had high myopia since aged 7 but see very well wih contact lenses. I decided to have the implants because vision was less good with begining cataracts and  trouble reading. I am very pleased with the result of the implant so far because my vision is already good for most functional activity including reading, with my left eye. However distance vision is not as good as with my right  unoperated eye with its contact lens. I wore gas permable lenses for many years , transfering to soft lenese for 3 weeks right up to my biometry and wonder if this affected calculation of the the lens strength? The trouble is my doctor had to send away for my lenses because he did not have a stock of such ones in my strength.After my transplant  I was given a form for my optician to refract my operated eye before my net implant  so that the power of the second lens can be calculated as accurately as possible I don't know whether I should insist on asking the doctor if this changes things before I turn up at the clinic for my second "op". It is a bit of a conveyor belt, I am worried that he may implant the lens he sent for irrespective of the opticians report. I certainly would not feel confident driving if my next implant produced the same level of distace vision as the first. I know that there is an adjustment period but have read that it is the distance vision that improves first with the Tecnis ZM900 and not last. I don't mind waiting for my second implant to see how things go. Also the nurse I saw after my first transplant mentioned that the doctor could "tweak" my second implant if necessary . I  hope she didn't mean he could just choose a stronger lens because I know they don't have them  stock! As you can see I am having a crisis of confience. Sorry for being so neurotic but I would appreciate any advice!

[cdn_glenn]

I've had Tecnis ZM900 multifocal IOLs for two years.  The first month was quite an experience.  I think my distant vision started out better than yours and near vision was good, but I couldn't read fine type.  I remember chanting to myself, "So it's going to be like this from now on?"  I can only say that in two weeks general vision was better and in a month vision near and far was good.

Part of my "plan" was to have Lasik surgery to compensate for any residual astigmatism and focus issues.  Thankfully I didn't need to do that at all.

Take your time before your second surgery and definitely express your concerns on correction with your doctor.

[Sandy Feldman, MD, MS]

Dear myopic2008,

I recommend that you hold off on your second eye until you have discussed your concerns with your eyeMD.  It sounds if you need to understand what your prescription is; and how close to the desired target prescription as well as what your doctor is planning for the second eye.  It does take time for the eye to heal.  There is some variability in the achieve prescription as well following cataract surgery so wait until you are satisfied to have your second eye surgery.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[cdn_glenn]

Very excellent to hear your vision is improving.  It's only seven days since surgery and I expect you'll see great improvement in the first month.  I'm glad your doctor is satisfied to wait until you are ready for a second surgery.  Also glad he's a competent practitioner rather that a good salesman.  (I've often wanted to start a thread in the Eye Care Community entitled, "Qualities for an excellent MD: Camp Counsellor or Skilled Practitioner?"  It seems they're rarely both in the same package.)

You are hinting that you might be focused favouring near vision.  Your eyes might be starting out a bit different than mine did with the ZM900s, but I think you'll find a lot of change.  Milestones at two weeks and one month were memorable for me.

Please report in again with your progress.  I am very interested.  Good luck!

[myopic2008]

Re Tecnis multifocal ZM 900 implants
Thought I would just let you know I saw my MD today and he suggested deferring the second op till I was more satisfied with the first eye, which is a very satisfactory outcome for me so thanks once again.
Not that he was willing to answer my questions satisfactorily-I suspect he is a brilliant ophamologist  but without a bedside manner!
I have noticed lots of posts about multi focals -lots of  queries and problems so I will notify my eventual outcome on this site.All I can say so far is that the op was painless, recovery very quick and having been very myopic(-10 D) plus needing reading glasses I can now  after 7 days see brilliantly to read, use a computor , and am well satisfied with near and intermediate vision-as good as with my contact lenses (reading is even better) The problem is distance vision which is below par for driving in he implanted eye. The MD seems to think it will all improve and I am being impatient. I am seeing him again in a month so we will see (even better I hope!)
My advice to anyone who has high myopia which is  curently well corrected by specs or contacts is to wait to let the first eye settle before having the second. Otherwise you may have a period of adjustment when you see less well than before. However if you have poor corrected vision in both eyes eg because of bad cataracts then the reverse will be true because your vision should improve immediately in both eyes.
I note some people have expressd a interest in travelling outside the USA and Advance Vision Care in Harley Street London offer a package which includes 2 days hotel for around £2,500 per eye.(English Pounds) (flights not included of course) Dr Goran Helgason is one of the doctors there.They should be easy to find on the web.  I had mine done in Lancashire, England.
myopic 2008

[myopic2008]

Dear cdn glen, That's inspiring to know from soeone how much things can improve.! Thank you for going to the trouble of responding. I don't think in my case I can have laser treatment later so everything hangs on this next eye. I  am taking your and Dr Feldman's advice and requesting a discussion about what is planned for my next eye before going ahead.I would have felt timid about this if she and yourself had not advised this. From what I read with the Tecnis ZM 900 it is the distance vision which comes best first and your experience conformed to that. I'm so glad you are satisfied with he final result and I have really benefitted fro your encouragement! By the way my optician (not the surgeon who did it) sys he can tell I am in the catagory who is very likely to develop the capsule opaqueness-which is esily correctable-and one can't become complacent about having regular eye checks!
Thanks again!

[myopic2008]

That is such a reassuring reply-Thank you- and it gives me permission not to be swept along because of reluctance to ask awkward questions ,leaving it all on the Doctor to do the right thing. I am spening hard earned savings on something that will affect the rest of my life. I  will take your advice and not proceed till I can discuss my concerns wirh him and are more satisfied.' Thanks a milion!