Anyone else adapted to Lentis Mplus lens after two months?

[hankhill23]

I originally posted this as a reply to another thread but thought I'd start my own as I'd like to get some opinions.   I had the Lentis M Plus lens implanted into my right eye 6 weeks ago.  The left eye implant that was planned for a week later was postponed indefinitely as I had massive ghosting/double vision and glare in the right, which caused me enormous distress and concern.  I have since had two other checkups, one was unscheduled as I was so worried, and my one month post-op was l2 weeks ago.  I was convinced that the lens was decentred but the optometrists say it’s perfectly centred.  It feels like I’m forcing my eye to see distance through the close up part of the lens.

I won’t name the clinic yet as I’m undecided whether I’m happy with them or not.  I’m trying to convince myself it’s getting better (but I don't think it is) so I’m keeping an open mind for now.  It’s only been 6 weeks, but they are easily the longest 6 weeks of my life!  As things stand, if my left eye had been done after a week and had the same effect, I would be almost housebound, I certainty would not have been able to drive.   I’m only a young 53, so I’m glad I still have a good untouched left eye (with a contact lens).

I have been assured that the eye/lens will “settle” and my brain will adapt, so I guess only time will tell.  The clinic will happily explant the Mplus lens (so they say) and replace with a monovision lens, but that really defeats the whole exercise, so I do want this to work.

Has anyone had experience of these bifocal type lenses being de-centred and re-positioned?  if not, I’d love to hear from anyone who had the same ghosting/blurred vision which lasted at least 5-6 weeks then cleared.

Anyone tried exercises to help with Neuroadaptation?  This company in the US will happily sell me their program for $500… http://www.revitalvision.com/

[devymandagi]

Hi, I'm an ophthalmologist and refractive Cataract surgeon from Indonesia. I'm very happy to find this discussion.  
1. I would like to say that there is no artificial lens (implant) that perfect. Every implant, multifocal, monofocal, have advantage and disadvantages. This is important to discuss with doctor. He/she will help you choose the right implant to suit your need. This will be a long discussion, maybe more than 1 appointments.
And for now, oculentis M plus is the best multifocal implant in the market compare to other lens.  Maybe in the future, technology will bring us better lens.
2. Neural-adaptation is real. Having multifocal both eyes in short distance time of surgery will help Neural-adaptation. It's like watching 3d movie with glasses. Rig Rig will see red image, left eye will see green image. But with both eyes brain with fuse this image into 1 3D image. With multifocal implant (like Mplus), right eye will see a slighly different image with left eye, but wit both eyes brain will fuse both image into one good  image, and ignoring the not important image l ghosting, hallo,etc. Yes, it still there, but your brain will ignore it.
It's the same principle with your skin ignoring the feeling that you are wearing clothes. Because it's so routine...
I hope this help. Sorry for my bad english.

[JohnHaganMD]

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[Rockroad]

I had IOL replacement surgery for my cataracts two years ago.

I got a Lentils Mplus +3.0D in one eye and an Mplus (comfort) +1.5D in my dominant eye.

It has worked very well and I can see all distances clearly without glasses.

Initially I noticed a little bit of ghosting at night for bright things like streetlights, but over time it reduced greatly. I guess if I look for it specifically at night in high contrast situations it is still there but my brain doesn't trigger any abnormalities any more.

They didn't have the Mplus +2.0D at the time but the 1.5 and 3.0 have combined really well together. It doesn't feel like one eye is doing the work for reading and the other for computer/intermediate - both eyes work like one.

I've basically forgotten that I even have IOLs. Very happy overall.

[sunnygirl0858]

thanks for the update; glad it has all worked so well for you.  I am still waiting - my other cataract is not too bad yet, so no rush for me.

[JohnHaganMD]

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[tyrotrainer]

Please see my comments below. ...I think you will be very pleased in 2 years time. ... your mindset is exactly same as mine and I am improving ever so slightly every day.

[tyrotrainer]

I'd just like to clarify my last because I know that people would like to know exactly what happened to other people, and I didn't explain fully my before /after.

Before I had below average distance and needed reading glasses, the reading glasses were getting stronger with age,  but even with them I struggled with small print less than say font size 8. Night vision was ok.

After I have amazing distance and reading vision in good light...I can read the tiniest print on food packets etc without glasses... easily below font size 8, but only in good light.  In poor light I'd say I'm now around the level I was pre-op but with halos.  

I am definitely improving gradually,  overall I am extremely pleased with my outcome.

Roy

[tyrotrainer]

I'm now 2.5 years implantation and still get halos but the star burst effects have pretty much gone.  I had a top notch surgeon at Moorfields in Dubai and he definitely was not a salesman, but he did explain the risks, and he WAS a believer in neufo adaption.  After a year I was so frustrated with my awful night vision that I was close to asking for explanation.  He said he'd do it but he felt strongly I should give it another year at least... up to me.

I'm so glad that I did wait.  My daytime vision is still awesome. .. like a hawk. .. watching TV used to be awful unless the room lights were full up,  driving was scary unless I used Pilocarpine drops... However now the night time effects are greatly diminished and I never notice ghosting or halos UNLESS look for them,  and my depth of field is ok.  I now drive at night without using drops, but I must say that my vision is nowhere near what it was at night pre-op.

I think explantation is a massive decision to make and a very personal one.  My experience is that I got scared after 12 months and almost went for lens replacement,  but I am now SO relieved that I stuck it out. I have a bad feeling about pushing one's luck when operating on the eyes.

Hope that helps the discussion.

Roy

[Googleeyes]

All interesting comments and versions of what I'm experiencing . I had Mplus30 lenses fitted in December and whilst I have great near vision , low light vision is near on impossible . Strangely enough if I hold my head back and look through the bottom of my eyes it's perfect ?

I have had so many appointments with  specialists and now 2 OE surgeons . These 2 surgeons actively put these lenses in , in 180 deg differences , when I inquired as to why the surgeon who is doing my follow up issues said it's to negate the symptoms I am experiencing . I have contacted both OE and Oculentis for a reason why this would be and strangely I haven't had a reply , a lens rotation is my only option .....

[neunelf911]

I've read this whole thread with great interest as I had this surgery in November (about 12 weeks ago now) and am experiencing a lot of symptoms described here....although to a lesser degree than some. I had no cataracts and am in my late 40s.

I had an MF-20 in one eye (23 dioptres + 2.0) and a week later an MF-30 (22.5 dioptres + 3.0) in my other.

My distance vision is now excellent with no discernable ghosting. Intermediate and near does have this, and this is a bit disappointing for me. I work in the IT industry so spend a lot of time on the computer and would prefer if I had no ghosting. Reading and up-close work is similar.

Don't get me wrong - I can work with it mostly. Certainly for intermediate distance anyway. Also I can get rid of it by squinting (presumably thus occluding part of the lens and removing one image). When I do that, i get a crystal clear image that is stunningly in-focus and detailed.

I have no plans to do anything much about this - prepared to give it plenty of time for the elusive neural adaption...so we'll see how that goes.

Overall I'm quite happy as I've got rid of my glasses. I can drive a car and motorbike in all conditions day or night (not at the same time) and generally walking around on the street have excellent vision now. Colleagues of mine still wearing glasses are amazed at how I see now compared to before.

I also have experience of my inter and close vision being different at different times - often depending on how tired i am etc...as others have mentioned here.

As I said, I'm adopting a wait and see approach, and hope that in a year's time, I'll either be so used to it that it no longer matters, or that something will have changed otherwise. At the end of the day, I could live with it like this...but would prefer it to be slightly better.

[DaleDietrich]

At my November 5 follow-up with Mplus Dr. my eyes had stabilized enough for him to schedule a PRK tweak. It was originally scheduled for mid-January but they did the tweak on Nov 19 following another patient’s cancellation.

There is good news and not-so-good news.

THE GOOD NEWS IS that the universal ghosting I have had at distance was resolved. Also, my distance vision is a tad better/sharper than pre-PRK, which makes sense since my world of ghosts is now a thing of the past.

THE NOT-SO-GOOD NEWS IS that up to this point (3 and a bit weeks later) my close up vision was trashed and I still have ghosting for near-vision on computer screens, books and such. Mostly anything close up with a white/bright background. I have purchased a pair of cheap reading glasses from the drug store. A 2.25 prescription and that seems to work (though not well) for now for close up. I believe that my prior reading glass/bifocal prescription was 3.5 from you so 2.25 is an improvement but the whole point of this $5K and what looks like it will be at least a year long odyssey was to get my close-up vision back. Sadly I have had to reset my iPhone fonts back to super large. I SOOOOOO miss being able to read the fine print on the iPhone and anything else as I could pre PRK. I’m back to using a magnifying glass to read cooking instructions, labels etc.

GOING FORWARD: All is not to despair (yet). Dr. said that once my eyes have stabilized, again, he’ll see if doing another PRK tweak for the near vision loss will make sense. Also, as per the literature, sometimes it takes months for eyes to settle and ‘maybe’ my near vision will return or get better over time. Also, I’m on the last week of using the various eye drops post-PRK and I know from in the past that they can sometimes adversely affect my vision. So maybe post drops things will get a little better. And, also sometimes I do see the smaller print better. So my eyes are clearly still fluctuating some during the day.

If/as my near vision improves I’ll get cheap lower prescription reading glasses to tide me over until this is finally resolved.

Technically Dr. is pleased with the healing post PRK and the MPlus lens. Everything is healthy and going as normal. He says my eyes will keep adapting over the coming months so, as I said there is some hope there. He said the cells on the exterior are likely still healing. He said that if I see better after blinking (as I sometimes do for a few seconds) that that is a good sign. What the tear drops do for a short time is roughly the same as what perfectly healed exterior cells should do over the long term. But even for the short periods post blinking, while better, the close-up vision is near as good as it was pre-PRK.

I asked if I may need the MPlus replaced with a better prescription. He says he knows my Mplus prescription is fine because I was able to see so good pre-PRK. But I’m not sure I understand that. If my eyes are being reshaped for PRK then won’t the lens inside need changing/tweaking. He never actually answered my question as to whether it was possible at this stage to even replace that lens. Some online sources say no – but those are lay people ranting when things went wrong with their MPlus lens.

A few more details/things I wonder about:

- Doctor keeps mentioning that my eye has a slight stigmatism and seems to think this is the source of some of the problems. But if it has a stigmatism didn’t he know this in advance? Didn’t he account for this when setting the MPlus prescription?

- Night time light (eg: street lamps, restaurant signs, headlights etch) and dark room light (ie: in an apartment hallway, in darkened restaurants) sheering is MUCH worse again. But apparently that was expected and should improve over time post PRK
- Ability to see/identify people in the distance (ie: beyond 10-15 feet) when there is a bright background (eg: outside during the day, or inside when in the back of a shop facing the exterior windows with people between) is significantly improved since the generalized distance ghosting is now gone
- I get some bottom ghosting at distances now (before it was all on the left). This doesn’t bother me at all though.

My next appointment with Dr. is set for January 14. I’m guessing I’ll have to go back month after month for a few months until my eyes settle again before any next steps are determined.
BOTTOM LINE: At worst my distance vision will be slightly better than it was pre MPLus because of the PRK and my close-up vision will be slightly better but not at all useful as I’ll still need reading glasses if things do not get better and cannot be corrected further. But there is still hope for better vision going forward. Just need to wait and ‘see’.

So, there we are. I’ll update you again after my Jan 14 appointment or subsequent appointments if/when there is anything significant to report.

…Dale

[2badeyes]

Pls contact me asap: tomlinson.m(at)gmail(dot)com

[wanlien3]

Hi there, I would like to think that the reluctance to implant a certain lens has to do with their (poor) prior experiences with it, but there could be other factors involved as well such as commercial considerations. Unfortunately it may be one of the unknowables.

But the general view of accommodating lenses in the ophthalmic community is that they don't really accommodate. It's difficult for the lens to flex if the capsule fibroses and stiffens. The effect of accommodating lenses is unpredictable, and accounts for the usual practice of aiming for 'mini-monovision' with these lenses. The near vision effect of multifocals is much more predictable, and that is why they dominate the market despite the side effects often encountered.

The other unpredictable aspect of accommodating lenses is that they vault, and occasionally if a capsular bag is small or contracts significantly there could be a refractive surprise or a refractive shift.

Monovision is predictable, and importantly, is easily 'reversible'. For example, you cannot easily reverse the halos of multifocals-you'd have to explant and exchange them. Monovision could be reversed with glasses/contacts/LASIK. Many patients have also tried monovision with contact lenses before, so it is something they are familiar with.

There is a reason for everything, and it behooves the doctor to explain everything properly to their patients.

[Chasman]

This may seem initially off-topic but please bear with me.

I had cataract surgery with OE over four years ago now.  The multifocal lenses from that era were taking and absolute hammering on the forums so I insisted on having the Tetraflex accommodating lens in both eyes.  OE were oddly resistant but I was determined (and paying with £4k of borrowed money) so they eventually (very begrudgingly) gave me what I wanted (though I was given a slight monovision prescription I didn't ask for and which I don't recall being discussed or even mentioned pre-op).

No halos, no glare, no neuroadaptation issues. UV protection as standard. I can read the tiny writing on food packets at arms length under a strong light in our kitchen, kindle Paperwhite at 8-10" no problem, kindle at 4" in bed needs a +1 reader, distance vision is absolutely superb in all conditions. 3D movies, no issues at all.  The only problem with night driving is that my eyes let in so much light now that modern Xenon headlights are very dazzling but there are no noticeable artefacts from the implants.  I am absolutely delighted.

My wife is about to have cataract surgery and is keen to follow my tried and tested path if her eyes are suitable for the same IOL.  We have only been for the first consultation, scans and measurements etc. but we are already getting some push-back about dictating what we want rather than accepting the MPlus lens OE seem to prefer.

I need to be clear: if there is an *objective* reason Tetraflex is unsuitable for my wife then fine, we'll consider alternatives.  I also realise that, perhaps, I was exceptionally lucky.  Just as there are a small percentage of failures like the one's described here there is another tiny group who have an exceptionally good result.  I'd like to be treated like a grown up and told that they switched lenses because they had problems with the one I have or found distinct advantages with the one they are offering now.  Or told they have a range of lenses and a set of rules which dictate the most suitable.

But we didn't get that information, just that, as a company, they have a preferred lens they have few problems with.  Private health is supposed to be about the magic word "choice" so we'd like to choose.  It's not as if we've Googled a lens they have no prior experience with, I can understand the implantation procedures will differ... but it's the same company, same lens and even the same surgeon.

We're having what they call "second consent" when I gather we'll be talking to someone with more detailed knowledge of the available products so I hope we can resolve the situation then.

My questions are these:
Why were OE so reluctant to implant Tetraflex and so keen on MPlus?

Why are informed customers who have done their homework seen as problematic?  It's called "informed consent" after all...

Why are surgeons so obsessed with monovision?  Relying on neuroadaptation is clearly a problem for some patients, it is poorly understood and inconsistent from one person to another.  Both monovision and multifocal lenses rely upon this phenomenon which creates a problem if you make it a core part of your standard operating procedure.

Why is an apparently inferior technology (multifocal) dominating the market when an apparently superior alternative (accommodating) exists?

[joojeh]

I posted earlier in this thread that I was planing to have RLE surgery using Lentis MF-20 multifocal IOL. This lens has a +2.0D near (MF-30 has +3.0D near add).

I had the survey on my second eye 2 days ago and I am already free from glasses. Vision is crisp and sharp at all distances. So far (touch wood) I am delighted with the outcome. The only slight observation is that while watching TV if there is bright white text on black background I see a small ghost/shadow of each letter underneath it, giving it a 3D effect.  This by no means bothers me and I had prepared myself to expect it. I have already learnt to ignore it.

The adaption period for this lens is immediate.  I could not have put up with months of waiting while my eyes adjust to the lens.

[Jo000]

All I can do is offer sympathy I'm afraid Lynda. My surgeon wanted me to explant earlier this year (just to stop me complaining about the M-Plus I think) but I decided against it. If I was you, I'd go back to the original surgeon and ask for detailed explanation as to why he can't replace the monovision. I'm guessing it's something to do with the length of time that's passed since your explant. The lenses bed themselves into the eye and when everything's healed up it's very difficult (and very risky) to remove them. However, I did see a surgeon at OE in Nottingham last year who did say he had successfully performed an explant after nearly two years - but if you go down that road you'd have to make absolutely sure that the surgeon was very experienced and had done such an op before. Good luck.

[Lynda199]

I have read with interest all the posts on this thread.  I had my MPlus lenses explanted just over two years ago, but very much wish I hadn't had the first one (R/E) explanted.  I contacted my surgeon at the beginning of the year to ask if he can put the MPlus back because my vision was nowhere as good with mono-vision lenses.  He said he could not do this, but didn't give me a specific reason why.  I therefore tried to find another surgeon in the London area who could do the surgery for me, but no-one was interested because they didn't perform the original surgery.  Can anyone suggest anything, please?  Am I really asking for the impossible?

[DaleDietrich]

Hello All:

I had my follow-up appointment (2 months post procedure) with surgeon yesterday. I had personally observed that from my last appointment on August 6, my distance vision has become clearer while the ghosting on the left and light bleeding in from the right has remained largely unchanged. I had also noticed ghosting as close as 18” in the last two weeks - ie: when looking at the computer screen there is ghosting of the black letters on the white background and bleed of the white background into the right of the black letters. This is new. I hadn't noticed that back in August.

Here is the results from my visit with surgeon:

- My eye has measurably improved despite continued ghosting and glare (ie: my prescription has improved)
- On August 6 he had measured some near sightedness and a slight stigmatism in my right eye. He said both of those have improved in the last month and have measurably dissipated (ie: my prescription has improved on both fronts). He verbally told me the numbers but I don’t remember them.
- As a result of the eye improvement, Dr  is even more optimistic that my eyes can be corrected without harm to my newly MPlus-improved near vision.
- Dr. believes PRK tweaks should correct both near and far ghosting and bleeding
- Dr. wants to see me again in a month (I have an appointment for October 8). He wants two visits in a row where prescription doesn't change before doing PRK.  He wants to be sure eyes have settled.
- He still believes the problems I am having are a result of my 1999 Lasik. He will be doing PRK correction instead of Lasik correction because he said it is unsafe to do a second Lasik procedure on the same eye.
- It was a very positive visit and he was even more optimistic than on the last visit that I will achieve a good result after PRK (ie: ghosting and bleeding should be history).  

I'll report back after my October 8 appointment.

[sunnygirl0858]

Hi all
For what it's worth I have booked an appointment at Optegra (recommended by my Optometrist) to consider my different options for my right eye. For new readers I had mplus in left eye a year ago because I have cataracts. I get the afore mentioned halos and glare, but vision is so much better than with cataract, and I have no regrets. Optegta is twice the price of OE, and I have the same budget issues as anyone else. However they offer choices that OE seem to prefer not to get involved with. I am hoping to learn that they do not operate along the same production lines as OE. I will report back following the appointment on 25 September.

[joojeh]

It might be a matter of timing.  I think the MF20 with the +2.0 near ADD is fairly recent.  

[Jo000]

That's interesting - the bit about the MF20/MF30. I asked what lenses had been put into my eyes and was told LEFT- Power 15d MPlus Add3, and RIGHT - Power 16d MPlus Add3. In light of what you've written here, that translates into them both being MF30. Why on earth have my surgeons not mentioned an alternative MF20 to me I wonder? They offered only a monofocal explant.
Anyway, please let us know how you get on - though I'm more than a year post-op now and it's probably too late to do anything.

[joojeh]

I have planned surgery in October.  My surgeon is going to use Mplus MF-20 ( this is the same lens as MPlus MF30, but with +2.0 near add instead of +3.0).  This lens is not advertised on Oculentis web site.  Its near add power is somewhere between the "Comfort" lens and the Mplus MF30.

Surgeon  has advised me that I may need reading glasses for fine print, but the advantage is that I will have better intermediate vision and less glare/halos/ghosting compared with MF30 lens.

[DaleDietrich]

Saw my surgeon today (3 weeks post MPlus implant)

- As with my eye doctor last Friday, he was able to correct the ghosting away in the office (though I'm not sure if the light bleeding issue was corrected given the lighting conditions of the exam room)
- He says my eyes may/will probably settle down more over the next few weeks.
- He agrees that the antibiotic drops I'm still taking for one more week could also be playing a part in my poor distance vision
- If my eyes don't settle enough he says he will definitely be able to correct with PRK.
- He says we need to wait three to four months post procedure before we do any PRK to be certain eyes have settled.
- He says my issues are a by-product of my prior 1999 LASIK and that the MPlus lens is positioned perfectly (My eye doctor also thought the lens was inserted correctly).  
- If a correction is needed, it MAY affect the wonderful close-up vision that the MPlus has given me.
- He said that, in that case, he will be very careful to strike a balance between close up and distance in accordance with my wishes (ie: being able to read close up and computer screens are more important to me than perfect distance vision).
- Accordingly he will weigh any PRK correction in favor of my close up.
- All that said he says there shouldn't need to be much of a trade off. With the completely corrected eyes in the exam room I was able to read normal book-sized print.
- My next appointment is Sept 10 to check-in to see if things have improved.
- All of this will be at no additional charge

...Dale

[Sweepyyyyy]

My multifocal lens replacement was 8 maths ago and I am as all in this link: glare, halos, distortion etc. The option of exchange to mono focal has been mentioned, at this stage with a near guarantee of perfect long distance vision and no more side effects. That is not what I've read here!!! How are your eyes now?

[DaleDietrich]

Well my eye doctor disagrees with you Jo000. I specifically asked her if this is something I can consciously do and she said specifically that the brain will adapt by itself it it can adapt. She didn't say it would fix radical ghosting. She specifically said I will probably need a LASIK touchup if the eyse don't settle down. But she was very clear that the brain can fix/adjust too some slight issues in some people without any consicous effort. It will either happen or it won't. Since she has been an eye doctor for 25 years and I am not, I take her at her word. She is NOT part of the organization that provided my procedure. She did NOT recommend me to them. She has no dog in this hunt. She is a completely objective doctor who I respect and trust having gone to her for over 15 years.

[Jo000]

Hi DaleDietrich
The jury is out on so-called neuro-adaption - I think perhaps it's just the terminology that's misleading. My GP referred me to the NHS eye hospital at Nottingham (QMC). The consultant there told me there was no such thing as neuro-adaptation in vision - basically there are two images falling on the retina, one from the top part of the lens and one from the bottom half. The neural network between your eye and your brain will relay both images no matter what. How your brain interprets that info is still a mystery. We know the brain can add information as it seeks out patterns and  tries to make sense of them, but can it take information away? I don't think so. I think this so-called neuro-adaptation to ghosting is just consciously learning to ignore it - a bit like children are told consistently what 'reality' is, even though they may 'see' things that adults can't/don't - it's called consensus reality. HOWEVER - there are those that claim you can cure eyesight defects by asking for healing in a lucid dream (that's a dream where you know you're dreaming) - in fact I know someone who achieved this and no longer needs glasses. I'm experimenting with that - it keeps me hopeful :)

[Soozie64]

Thanks Superam, I'm 'watching this space', sounds like you are now having a whole new set of problems to deal with. I'm interested to hear about the YAG procedure, I'm needing that now but putting off for as long as possible for explant reasons/options.
Soos