ReStor IOL and Astigmatism

[Susan12345]

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

[Susan12345]

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

[JodieJ]

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.

[Susan12345]

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

[JodieJ]

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)

[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.

[blue92]

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.