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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
Jodie, in the Mono or Multifocal thread you said that my doctor's statement that any time you went into an eye for surgery you had a one in a thousand risk of complications casuing blindness in that eye was **** ****. What kind of statistics have you read? I've been trying to find actual statistics but every site I can find on cataract surgery is very vague. And of course there's virtually nothing writtten about explants. Susan12345
What is your best corrected vision for distance and near? Your statement that your vision keeps changing when tested lends further support to the hypothesis that your distortion and blur is related to the misplacement of your lenses. (In addition to the fact that you can't have lenticular astigmatism with an implant.)
I think that even skilled and experienced surgeons aren't accustomed to the degree of precision required by the multifocals. Apparently, even tiny deviations from the correct placement can cause horrible problems with vision. In another thread, blue92 posted that the source of his/her vision problems were finally diagnosed by wavefront analysis and slit lamp digital photos. But few surgeons are doing these tests when patients return with complaints, and the lenses seem to be correctly placed. (Maybe some patients are even dismissed as being "overly demanding perfectionists.")
I've read that blindness post-surgery is related to infection. I suppose that happens more often in third world countries. It might also be related to noncompliance with using prescribed antibiotic eye drops and failure to keep post-surgery followup appointments. I've read that noncompliance is highest among the elderly, some of whom might lack the dexterity to apply the drops correctly. But Susan, this certainly wouldn't apply to you. Nothing is ever guaranteed, but didn't your last doctor say that he could explant your lenses safely?
I think that even skilled and experienced surgeons aren't accustomed to the degree of precision required by the multifocals. Apparently, even tiny deviations from the correct placement can cause horrible problems with vision. In another thread, blue92 posted that the source of his/her vision problems were finally diagnosed by wavefront analysis and slit lamp digital photos. But few surgeons are doing these tests when patients return with complaints, and the lenses seem to be correctly placed. (Maybe some patients are even dismissed as being "overly demanding perfectionists.")
I've read that blindness post-surgery is related to infection. I suppose that happens more often in third world countries. It might also be related to noncompliance with using prescribed antibiotic eye drops and failure to keep post-surgery followup appointments. I've read that noncompliance is highest among the elderly, some of whom might lack the dexterity to apply the drops correctly. But Susan, this certainly wouldn't apply to you. Nothing is ever guaranteed, but didn't your last doctor say that he could explant your lenses safely?
Different eye exams have listed me as anywhere from 20/20 in both eyes to 20/40 in the right and 20/30 in the left. The prescription I had a month after my 2nd surgery was OD: +0.75-1.00x032 OS: +0.50-0.75x007 Add +2.50 OU. Four months after surgery (with a different optometrist) it was OD; +1.00-1.75x047 OS: +0.50DS Add +2.50 OU. Though according to my surgeon my vision is perfect, even the reading problem is just because I hold stuff too close, the fluttering, which incredibly he didn't even mention in his notes, was just because I was tired. Yeah, I'm definitely pegged in my records as an anxious neurotic. Even the note written by an optometrist several years before I had surgery, when I was 1st informed I had cataracts AND signs of drusen (early signs of macular degeneration) wrote incredibly, pt. seems overly concerned as to why she has these problems at an early age (in my 50's). Overly concerned?!!!!!! Do most people react "Oh, no big deal!" Of course it's no big deal to the doctors, but it sure is to us!.
I called the latest doctor's office to have my records sent, so I'll see if he had done either of those tests. He did a very throrough exam the 1st time and told me to get my last 6 years worth of eye records and return in a month. That time he did a very brief exam and started to read my records, realized he didn't have time and said he'd called me after he'd read them. He did call me the next day and talked to me for about 40 minutes, giving me his statistics, the one in 1000 etc. Then he realized how long he'd talked and said that was all the time he had to give me. I asked if I could E-mail him any more questions, but he said no, he didn't do that, if I had more questions to make another appointment. Basically, it was, I've given you the facts, call back if you want to take the risk. So he didn't make it sound as risky as the 1st doctor, but definitely not a piece of cake either.
I guess if he didn't do those tests I need to find someone who does. Though I'm really not clear how repositioning the IOL's would be significantly less dangerous than exchanging them. You'd still have to open the capsule, with the risk of its rupturing. Susan12345
I called the latest doctor's office to have my records sent, so I'll see if he had done either of those tests. He did a very throrough exam the 1st time and told me to get my last 6 years worth of eye records and return in a month. That time he did a very brief exam and started to read my records, realized he didn't have time and said he'd called me after he'd read them. He did call me the next day and talked to me for about 40 minutes, giving me his statistics, the one in 1000 etc. Then he realized how long he'd talked and said that was all the time he had to give me. I asked if I could E-mail him any more questions, but he said no, he didn't do that, if I had more questions to make another appointment. Basically, it was, I've given you the facts, call back if you want to take the risk. So he didn't make it sound as risky as the 1st doctor, but definitely not a piece of cake either.
I guess if he didn't do those tests I need to find someone who does. Though I'm really not clear how repositioning the IOL's would be significantly less dangerous than exchanging them. You'd still have to open the capsule, with the risk of its rupturing. Susan12345
It's really disgraceful that you paid good money for premium IOLs and ended up with your current vision. And you're right--the optometrist's comment about your "over concern" about developing cataracts and signs of drusen at an early age is totally ludicrous.
Susan, would you really want to get your ReStor lens re-positioned (rather than explanted)? If so, I suggest that you set up another appointment with your last doctor. Tell him that you recently had a long talk with an optometrist from Indianapolis (maybe the brother of a close friend who was in town for the holidays) about your vision problems. Explain that the optometrist has treated post-cataract surgery patients with symptoms very similar to the ones you're currently having. Tell your doctor that the optometrist believes that your IOLs may be very slightly decentered and/or tilted. Say that this needs to be verified by wavefront analysis and slit lamp digital photos. Say that the optometrist suggested that your doctor contact Dr. Kevin Waltz, a cataract surgeon in Indianapolis, for detailed information about how to diagnosis and treat this problem. (Believe me, if you're honest and say that you read about all this on an internet forum, it will not lead to the outcome you're looking for.)
Given all the frustration and anxiety you've experienced due to your ReStor problems, I think you might be happier explanting them and getting monofocal lenses. You don't have any astigmatism anymore (per your current doctor), so if you targeted the focus of your new lenses for near/intermediate vision (like you want), you probably wouldn't need glasses at all when you're at home. You'd only need glasses for distance vision.
Susan, would you really want to get your ReStor lens re-positioned (rather than explanted)? If so, I suggest that you set up another appointment with your last doctor. Tell him that you recently had a long talk with an optometrist from Indianapolis (maybe the brother of a close friend who was in town for the holidays) about your vision problems. Explain that the optometrist has treated post-cataract surgery patients with symptoms very similar to the ones you're currently having. Tell your doctor that the optometrist believes that your IOLs may be very slightly decentered and/or tilted. Say that this needs to be verified by wavefront analysis and slit lamp digital photos. Say that the optometrist suggested that your doctor contact Dr. Kevin Waltz, a cataract surgeon in Indianapolis, for detailed information about how to diagnosis and treat this problem. (Believe me, if you're honest and say that you read about all this on an internet forum, it will not lead to the outcome you're looking for.)
Given all the frustration and anxiety you've experienced due to your ReStor problems, I think you might be happier explanting them and getting monofocal lenses. You don't have any astigmatism anymore (per your current doctor), so if you targeted the focus of your new lenses for near/intermediate vision (like you want), you probably wouldn't need glasses at all when you're at home. You'd only need glasses for distance vision.
Well, Blue's symptoms (ghosting, double vision, and poor intermediate vision) were totally different from mine. Hopefully, he'll write back and let us know the results of his surgery to reposition the IOL's. But it makes no sense that this one doctor is the only one who knows about these tests. I live in a city with a metropolitan population of about 2 million people, if these tests truly are valid there have to be doctors here
who know about them. My doctor may even have done them, when I get his records, I'll see. If nobody but this one doctor in Indiana has ever heard of them, I can't say I'd put much faith in them. I suppose it doesn't really matter, if I decide to go through the risk of surgery it would probably make more sense to just have the ReStors explanted instead of a repositioning that might not work. Though of course it would be nice to have ReStors that actually worked liked they're supposed to, it sounded so great, not to constantly be switching glasses, that why I sought out the doctor who did them in the 1st place. But as "they' say, things that sound too good to be true usually are. Still, it wasn't like I went to some quack who advertises in the Sunday comics page, the doctor who put them in was supposed to be one of the best and I have no way of knowing if this new doctor is any better. Susan12345
who know about them. My doctor may even have done them, when I get his records, I'll see. If nobody but this one doctor in Indiana has ever heard of them, I can't say I'd put much faith in them. I suppose it doesn't really matter, if I decide to go through the risk of surgery it would probably make more sense to just have the ReStors explanted instead of a repositioning that might not work. Though of course it would be nice to have ReStors that actually worked liked they're supposed to, it sounded so great, not to constantly be switching glasses, that why I sought out the doctor who did them in the 1st place. But as "they' say, things that sound too good to be true usually are. Still, it wasn't like I went to some quack who advertises in the Sunday comics page, the doctor who put them in was supposed to be one of the best and I have no way of knowing if this new doctor is any better. Susan12345
The doctor who implanted your ReStors was probably a good surgeon but relatively inexperienced with multifocals. I'm sure that there are experienced docs in your area who have re-positioned multifocal lenses. You might try posting your location, and hopefully one of the manufacturers' reps could recommend someone. Or you could just get your ReStors explanted. But you should probably do something in the next month or two.
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