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ReStor IOL and Astigmatism

I have written before about my ReStor woes and trying to decide whether to take the  risk of having them explanted and replaced with monofocals.  I am still trying to figure out one of the things the doctor I consulted said.  I had astigmatic keratotomy done with my cataract surgery, but still have significant astigmatism in my right eye.  I thought my surgeon had not been able to correct my astigmatism totally, but the latest surgeon said in fact I no longer have astigmatism via corneal exam, though clearly do on refractive testing.  I still don't understand how that's possible.  The doctor said something about maybe it's in the lens, but wouldn't elaborate further.  If someone has lens related rather than corneal astigmatism, is this something that I might have had with my natural lens before surgery, something caused by a defective IOL, or something that has to do with my  eye's reaction to any IOL?    Susan12345
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Avatar universal
My question actually got printed, despite the fact that clearly my ReStor lens didn't work!  Of course, the doctor told me to get a second ReStor.  (He forgot to mention that I'd better hold on to those reading glasses!)  Maybe I'll have to write him again in a few weeks to let him know I followed his advice, but I still can't read the comics without my old glasses. (He'd probably tell me call his office to set up an appointment for LASIK enhancement.)

The website (Charlotte, NC newspaper) with Christenbury's column clearly refers to it as "advertisement."  I assume that it's advertising Christenbury's practice (rather than Alcon's products).  Implanting ReStors can be profitable, and recommending them to everyone certainly expands his pool of prospective patients.  Even without an income from Alcon, he must be raking it in.
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Avatar universal
I wrote to Dr. Christenbury, too.  I said that I had had my first ReStor implanted 6 weeks ago, and I currently had good distance vision but no improvement whatsoever in my near/intermediate vision.  (I think any doc would suspect a problem in this situation.)  I also said that my surgeon found no astigmatism or PCO, and he now wanted to implant the second ReStor, although I had reservations about doing this (given the poor results of the first one).  I can't wait to see if he prints this question, and what his advice will be.
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Jodie, I took your advice and wrote Dr. Christenbury a post in which I didn't mention one negative thing about the Restors and he actually answered it.  I just asked about the wavefront analysis for diagnosing poor results from multifocal IOL's, didn't say one word about whether they were Restors, Rezooms or any other kind.  According to him the slit lamp test was all you needed, unlike Blue's doctor's views.  How does this Dr. Christenbury even have time to write all these posts, in addition to the 5000 Restors he says he's done?   I just skimmed through the thousands of posts but only found one where he didn't recommend Restors, that was for a patient with only one eye!   (Of course, I assume the monofocal he recommended for that patient was an Alcon brand too!)    Susan12345
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Avatar universal
It would certainly be unethical (but maybe not criminal) for Dr. Christenbury to write an advice column about eye surgery issues, recommending that virtually everybody get ReStors, without revealing that he was a paid consultant for Alcon (if, in fact, he were).  It's not clear whether he's just trying to drum up business for his own practice, without having a formal financial relationship with Alcon.  In any case, his continuous high praise for Restors with no attention/concern for the downside of these lenses does seem to border on an ethical violation in itself.  Actually, the doctor's credentials seem to be excellent.  I think that he may have been one of the docs that Hoddy consulted.  (I wonder how Hoddy's doing with his ReStors; we haven't heard from him for awhile.)

Susan, your situation is complex and emotionally wrenching.  Please keep us posted about your progress.
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Well, I think a paid consultant's comments could be criminal.  If someone chose to have the Restors because the paid consultant,  pretending to be writing an objective advice column without indicating that they were paid, raved about them,  and the person had complications and had an explant and went blind from the explant, it's no different than if the paid consultant had shot the person in the eye and made them go blind that way.  Susan12345
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Avatar universal
You're probably right about that doc's relationship with Alcon.  But it's still conceivable that PCO is affecting your near/intermediate vision, especially if the problem seems to be getting worse.  My cataract surgeon recently told me that I have the beginnings of PCO in both eyes.  (It's us "younger" cataract patients who are at higher risk for PCO; apparently, it rarely occurs in geriatrics.)  It might be worth asking about it next time you see your eye doctor.
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Avatar universal
Being a paid consultant doesn't make somebody a criminal, IMO.  But I agree that it's only fair for a doctor to make his relationship with a manufacturer known, if such a relationship exists.  That's what's done in the professional journals, so I guess that most of the doctors reading the articles just ignore the hype.  But it strikes me that the entire field of cataract surgery is dominated by corporate interests, which is very bad for us consumers.  It means that we have no objective research for evaluating the performance of an IOL or for comparing different lenses (and neither do our surgeons!)  And even if we have a preferred lens (such as the Tecnis), it may be very difficult to find a surgeon who uses it.

Susan, it's interesting that your question for Dr. Christenbury was censored, presumably for its negative content about ReStor.  (You might want to try toning it down and resubmitting it to see what happens.)  That's why this forum is SO valuable--negative statements about somebody's experience with a product are not censored!
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Avatar universal
Well, all the doctors I've seen have checked for that, I think that's pretty standard.  From what I've read if I did get that,  the YAG procedure used to treat it would preclude any chance of an explant, so it's definitely not something I would be eager to rush in to.  I did finally get my corneal topography results in the mail today and even though my doctor had said my exam showed no corneal astigmatism, the test result said my right eye showed "the characteristics associated with keratoconus suspect (which sounded scary but when I looked it up basically seemed to mean astigmatism) as well as features similar to unclassified variations, whatever the heck they are.  The left eye had the characteristics associated with a normal cornea but also features similar to keratoconus suspect.  (Though how  could  they possibly say I have a "normal" cornea when I've obviously got keratotomy scars in it).   Anyway, I've got many many questions for the doctor which hopefully he will answer.   Yeah it makes me furious that a doctor will pretend to be writing an objective advice column and be paid off by the company for doing so.  Doctors (most) are RICH.  They shouldn't feel the need to prostitute themselves for drug companies.   Do they really not care that people suffer just so they can make a few extra bucks?  I guess not.   Susan12345
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Avatar universal
I don't know how to interpret your topography findings.  In your place, I'd want to know (1) whether keratoconus was a preexisting condition; (2) how the findings shown in the topography may be affecting your current vision; (3) what recommendations the doctor would have in light of these findings.  Hope you new doc can clarify everything for you.
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I discovered this doctor's column when googling a few months ago and did send him a question which he never answered, no doubt because of my complaints about the  Restors:  it is obvious by his continuous praise of them that he is paid by the Alcon company.  Susan12345
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Avatar universal
Blue, how are you doing after your IOL repositioning?  Did you have both eyes done?   I'm still trying to figure out how your lens were so decentered that even your wife could see it, but the other doctors you went to couldn't.  I googled the wavefront analysis test and it seems like most of the Lasik places boast that they do it but I couldn't find info on doing it to check IOL placement.  Needless to say, nobody advertises explants! Hope you're doing ok.   Susan12345
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Avatar universal
I recently discovered a website where the self-described "most experienced ReStor surgeon in the nation" responds to questions and problems about eye surgery.  There are hundreds of Q&A's posted.  The doctor's response to most inquiries about cataract surgery/IOL choice is to "get bilateral ReStors,"  which he apparently views as the best innovation since sliced bread.  However, there are a few interesting posts from people who already have bilateral ReStors and have problems with them. The doctor seems to attribute problems with near/intermediate vision to PCO (or the beginnings of it).  I know it's a long shot, Susan, but I was wondering if PCO could possibly be contributing to your ReStor woes.  (It's an easy condition to fix.)  In any case, to locate a link to the website, enter the words "Dr. Christenbury" "Restor" "expert" into Google.  (And if you decide to ask for the doctor's advice about your own ReStor experience--and he actually posts your question--PLEASE let me know.  I just can't imagine what he'd tell you, since he doesn't believe that a case exists where ReStors won't work.)

BTW, I checked several references, and all say that you can't have lenticular astigmatism after cataract surgery.
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Avatar universal
I have another appointment with the doctor next week and will write out a list of the many more questions I have.  Re the lenticular vs corneal astigmatism, according to the tech at his office they actually do leave a small ring of your natural lens in place, so it seems like I still could have some lenticular astigmatism, and if that's what it is,  it definitely seems to be getting worse in  my right eye.  I got my records but they didn't send any of the test results, however the tech in the office said they did do a corneal topography, though not a wavefront analysis, she seems to think that was only for pre Lasik surgery testing, not for determining placement of IOL's.  I'm just such an emotional wreck about all this, and trying to think how most tactfully to ask about the various other tests for checking IOl placement without making the doctor think I'm an neurotic fuss budget he doesn't want to bother dealing with.  At least he was very honest about the risks.   Quite aside from the increased risk of the Restors, which the  doctor who put them in never mentioned, if he had told me that 1 in a thousand risk of any eye surgery I would NEVER have had both cataracts done, just the one with the bad cataract, so would never have had the Restors. The cataract wasn't even that bad, who knows how quickly it would have progressed, I probably could have waited a lot longer,  all I know  for sure is my vision was certainly a lot better with cataracts than without.   And nothing is going to give me my pre surgery vision back, even if I have the IOL exchange and it works,  I'll still have these painful dry eyes,  surgery  will do nothing for them except possibly make it worse.   VERY FRUSTRATED Susan12345
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Avatar universal
I pretty much agree with you.  I thought it was interesting, though, because it probably comes closer to what these experienced and respected surgeons are really thinking than their public statements do.  Some of the comments were obviously not meant for patients' viewing.
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Kind of an insulting article I thought.  It certainly never occured to me to rearrange my doctor's eye drops in alphabetical order, but I'm definitely not upbeat or easygoing, so I guess don't have the ReStor personality.  I don't think it's personality so much though as some people's eyes can adapt to them and some can't.  The doctors just use the patient's personality as an excuse to take the blame away from themselves if it doesn't work out; they can say the patient was just too fussy.  But whatever, I just wish my doctor had recommended against a multifocal for whatever reason or excuse he wanted.  Instead he acted like they were the greatest thing since sliced bread.  Granted, I went to him because he was the only one at my HMO who did multifocals.  If you go to a Ford dealer he's not going to tell you to buy a Toyota.  Susan12345
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There's an interesting discussion about multifocals in the latest online issue of EyeWorld.  The participants are experienced surgeons who implant the lenses.  A couple of the comments were striking to me.  Dr. Mitchell Grossman, who implants multifocals in his patients, reportedly wouldn't want them in his own eyes.  And Dr. "Jay" MacDonald (who impressed me as the type of surgeon I'd like to have) seems to prefer what he calls "controlled monofocal continuous vision" (previously known as monovision) to the multifocals.  There are many other interesting articles in the archives of this magazine.
  
See: (www.eyeworld.org/article.php?sid=3560)
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K-D
Seems like we are in the same situation. I too am too fearful to have an explant. However, I do believe that doctors are just now learning all the possible problems with multifocal lenses that they did not know when we had our surgery.  Unfortunately, we are very early on in the multifocal implants.
Susan, since it will not matter any longer if we wait for an explant, since we are 3 months past surgery, this is what I am trying to do to reduce my anxiety.  I try an focus on the pluses.  Yes, I hate the inside blurr and aberrations. But I would hate not being able to see buttons on an elevator. or microwave, or keyboard.  Yes, I know that our priorities are not the same.  But try to concentrate on one plus from the Restor until you decide on explants.  And I read that they are developing instrunments that make explants safer. Hang in there.  Things keep improving.  Who know what will available in just a few years. I am guessing that someday to explant will be very simple and safe.
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Avatar universal
As you know, I had my surgery last week. The results so far are encouraging. The eye is still healing, but I already see progress. In good light conditions my vision is very good at all ranges, close, intermediate and distance. At low light conditions, the intermediate vision is still a work in progress.

Everyone is different and in my case, the slight decentering has caused a lot of aberrations (ie. ghosting, double vision, halos and glare). I had very much given up driving at night. Fortunately, I no longer have the debilitating glare and multiple halos. I have one halo around lights and, because it's a multifocal lens, it will always be there. Before this surgery I had such lousy vision that I'm supersensitive to everything. Having seen some changes already, I'm going to relax and let the brain and mother nature take its course.   K-D, like you, I had useless indoor intermediate vision.

In any event, the reason I feel comfortable and positive is that the option of explanting the lenses is still there if I choose to do so. After having the repositioning surgery, I have full confidence that if I choose to explant my lenses, Dr. Waltz has the technique, tools and knowledge to do so.

The plan now is to wait for the healing and adjustment and decide what to do next. Remember, I have lived for almost a year with decentered lenses (.7 mm on the right eye). By the way, the lenses did not move. They were placed as such from the beginning.

As for explanting your lenses, it is really up to the skill of the surgeon and if you find an experienced doctor, you should be fine.  I was a good candidate because of my age (52 yrs old) and in excellent health.  If you wish to contact me, my email address is ***@****.  I'll give my telephone number if you contact me for additional details. Bottom line is, I know how stressful it is to think that you have to live with this problem. Finding alternatives have made my situation much more bearable. I'm hoping to stay with multifocals but if, at the end of the day, I don't adapt, I'll switch to monofocal lenses.   Good Luck.
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K-D
Thanks for the update. And will keep your email. Very kind of you.  Do want to give you a little bit of hope too.  My halos could not have been any worse. At night, felt like I was living on a different planet. And honestly, starting my 8th month, my halos started to decrease, and are almost completely gone now. So, don't give up on getting rid of the halos.  Mine would cover the whole side of the street and large circles with spokes in them around any light source. I read somewhere that it can take one year for the halos to vanish. So, I have hope that yours will vanish too.
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Avatar universal
I don't believe that drusen is a contraindication for multifocals.  But multifocals are so new that doctors are still in the process of figuring out exactly what the contraindications are.

The last surgeon you consulted seems to be very competent.  After reviewing all of your records, he should be in a position to make recommendations to you.  I wish you the best, regardless of your decision.
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The referral doctor did say that retinal problems can cause problems with multifocals and a technician in his office did a lengthy macular degeneration test with one of the many mystery machines eye doctors have.  I've mailed in the form to get copies of my records,  so hopefully I'll see soon exactly what tests were done. But the doctor who did my surgery KNEW I had drusen before  I ever had my surgery.  If he had given me the slightest indication that I was a high risk candidate I would NEVER had the surgery.  It makes me angry.  He's a big wig corneal specialist, not a retinal specialist, but he would have to know if that would cause problems.  

I go back and forth in my mind, but when It comes right down to it, I just can't see myself going in for more surgery.  I'm just too afraid.    Susan12345
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Avatar universal
I just have one more suggestion--then I promise to quit overwhelming you with way too much information.  In a previous post on this thread, you mentioned that your optometrist saw early signs of drusen. (I don't think this is at all related to your current ReStor problems.  And from what I've read, a few small drusen are normal after age 40, and they can disappear spontaneously.)  I still think it might be a good idea to have this evaluated by a retinal specialist, if you haven't already done so.  Because of the loss of contrast sensitivity, multifocal lenses wouldn't be the greatest if you were to develop retinal problems in the future (which, of course, might never happen).  I'm thinking, though, that getting input from a retinal specialist might help you make a better decision about your ReStors (explant vs. re-position vs. nothing).  And it would really be great if you could find a doctor who was willing to take the time to address your concerns in depth.
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Avatar universal
Apparently there is more than one possible method to determine whether IOLs are correctly positioned.  I just came across an article in Ophthalmology Times (11/15/06, Cheryl Guttman) that uses anterior segment OCT to calculate IOL tilt and decentration.  (I've had OCT many times at my retinal surgeon's office, but I don't think that many cataract surgeons use or have access to this equipment.)  OCT is reported to be more accurate than the "Scheimpflug videophotography system" for calculating IOL tilt and decentration in some cases.  My impression is that IOLs are rarely perfectly positioned but are usually pretty close.  I also think that they may change position slightly as the eye heals.  Based on blue92's posts, probably some method for calculating IOL decentration and tilt needs to be done when there are unexplained vision problems with multifocals.  Hopefully, this will become standard practice as docs become more experienced with the multifocals.  But I suspect that many surgeons have been implanting multifocals for less than a year or two, and they are still on the learning curve as far as the fine points.
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Avatar universal
I don't know how much or if of any help this will be to you, but I am writing this to point out that even with normal eyeglasses the problems that may occur are sometimes difficult to identify. My wife had new bifocals made and couldn't stand to wear then because of blurry vision. She went back several times to have them re-adjusted, the only difference to your case being that the optometrist believed her when she said, she had a problem. He rechecked the prescription and the lenses, everything seeemed to be in order. After several adjustments (in your case that would be surgeries), they decided, to send them back to the manufacturer. They came back, they are fine, but no information is available as to what went wrong with them in the first place. The optometrist stated, that the manufacturer wouldn't tell him. This is not to say, that I believe, that there is something wrong with your lenses - at those prices, there better not be.
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