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Restor Lens Problems
I had cataracts removed 9 weeks ago right eye, 7 weeks ago left eye. I had the Restor lens put in both eyes. I have had nothing but problems and curious if anyone else has had similar problems. My first problem was light sensitivity. I had to wear my sunglasses inside for almost 8 weeks (my husband refers to our house as the Bat Cave). Fluorescent lighting is the worst and thats whats in my office. I had to work with the lights off for the first 8 weeks, I can turn them on now but the light still bothers me. I have dry eyes and it has gotten worse since surgery, the doctor put plugs in my tearducts but I'm constantly putting artificial tears in, which blurs my vision. Then my eyesight kept getting blurry with double vision. The doctor said I have Blepharitis and gave me Azisite. That seems to help but I have to use it every day along with warm compresses and a cleansing routine or the blurry vision gets worse. She now wants to perform laser surgery on me for a slight astigmatism I have. She says this will help, they gave me glasses to try on with the way it should look after surgery. I can see clearer but still double vision and she doesn't know if that will go away.
I went to another doctor for a second opinion and he said don't do the surgery if there is a chance I'm going to extract the lens and put in a monofocal lens. Now I don't know what to do. I'm scared to have these lens' extracted and would like to try and keep them in. We won't even get into the issue of the so called "halos" around headlights. They are such HUGE spider webs that I can not drive at night any more. Has anyone had any or all of my problems? Has it gotten better with time? Has anyone had the laser surgery for astigmastism after implants? Any help would be appreciated, my quality of life is 0 these days.
I went to another doctor for a second opinion and he said don't do the surgery if there is a chance I'm going to extract the lens and put in a monofocal lens. Now I don't know what to do. I'm scared to have these lens' extracted and would like to try and keep them in. We won't even get into the issue of the so called "halos" around headlights. They are such HUGE spider webs that I can not drive at night any more. Has anyone had any or all of my problems? Has it gotten better with time? Has anyone had the laser surgery for astigmastism after implants? Any help would be appreciated, my quality of life is 0 these days.
Obvious, typo correction, this: "Unfortunately usually most multifocals do have lowered contrast sensitivity compared to a multifocal," should of course have said "compared to a monofocal".
2 Comments
Do you have ReSTOR lens in your eye's?
re: "lower quality optics,"
There are obviously unfortunately downside risks with multifocals which patients should be educated about beforehand to be sure they really are comfortable with the risk/benefit tradeoffs. However I'd say "lower quality optics" isn't quite the right way to put the concerns you are referring to. In important ways the optics aren't "lower quality" in the sense that distance visual acuity is comparable in the modern multifocals, as a surgeon noted in a recent trade publication:
http://crstoday.com/2015/12/top-picks-of-the-year
'According to Dr. Mackool, for all practical purposes, the distance acuity provided by the AcrySof IQ Restor +2.5 D IOL “is equal to that of an aspheric monofocal IOL. The importance of this simply cannot be overemphasized.” '
Modern multifocals seem to have comparable distance visual acuity to monofocals in good lighting. Unfortunately usually most multifocals do have lowered contrast sensitivity compared to a multifocal, which means distance acuity is lower in lower light conditions which could be labeled "lower quality optics" in some sense. The newest generation of multifocals (low add bifocals, and trifocals that aren't available in the US) doesn't seem to have as much impact on contrast sensitivity as the older generations. Fortunately I didn't go with a multifocal, the Symfony uses diffractive optics but isn't a multifocal, and seems to have comparable contrast sensitivity to a monofocal.
Dyphotopsias, unwanted visual artifacts, are more common with multifocals (though a majority of people are happy with the results and don't report problems), but I'd labeled that a separate issue from "optical quality" partly since only a minority have problems.
re: " have more surgical complications "
I"m unsure what you are referring to here. Since most multifocals are now the same physical size and overall shape as monofocals, it seems like the surgical issues should be the same as monofocals. There are potential complications like halos that may lead to a need for more surgery to replace a lens. However I guess I wouldn't label that a "surgical complication" (which seems to refer to direct complications from the actual initial surgical procedure itself) rather than a complication that might need to be fixed surgically.
There are obviously unfortunately downside risks with multifocals which patients should be educated about beforehand to be sure they really are comfortable with the risk/benefit tradeoffs. However I'd say "lower quality optics" isn't quite the right way to put the concerns you are referring to. In important ways the optics aren't "lower quality" in the sense that distance visual acuity is comparable in the modern multifocals, as a surgeon noted in a recent trade publication:
http://crstoday.com/2015/12/top-picks-of-the-year
'According to Dr. Mackool, for all practical purposes, the distance acuity provided by the AcrySof IQ Restor +2.5 D IOL “is equal to that of an aspheric monofocal IOL. The importance of this simply cannot be overemphasized.” '
Modern multifocals seem to have comparable distance visual acuity to monofocals in good lighting. Unfortunately usually most multifocals do have lowered contrast sensitivity compared to a multifocal, which means distance acuity is lower in lower light conditions which could be labeled "lower quality optics" in some sense. The newest generation of multifocals (low add bifocals, and trifocals that aren't available in the US) doesn't seem to have as much impact on contrast sensitivity as the older generations. Fortunately I didn't go with a multifocal, the Symfony uses diffractive optics but isn't a multifocal, and seems to have comparable contrast sensitivity to a monofocal.
Dyphotopsias, unwanted visual artifacts, are more common with multifocals (though a majority of people are happy with the results and don't report problems), but I'd labeled that a separate issue from "optical quality" partly since only a minority have problems.
re: " have more surgical complications "
I"m unsure what you are referring to here. Since most multifocals are now the same physical size and overall shape as monofocals, it seems like the surgical issues should be the same as monofocals. There are potential complications like halos that may lead to a need for more surgery to replace a lens. However I guess I wouldn't label that a "surgical complication" (which seems to refer to direct complications from the actual initial surgical procedure itself) rather than a complication that might need to be fixed surgically.
Once again, the dry eye issue has nothing to do with the lens choice. You say the lenses were a premium "over Medicare" which implies that you had necessary cataract surgery (rather than that you replaced a still good natural lens with an IOL), and the incisions made for that are the same whether you get a monofocal or a multifocal lens. The incisions are what cause the dry eye side effect, not the lens itself. Fortunately the issue is only temporary for many people, and although its possible that having the issue after 7 months suggests it may be permanent, there is still a chance it will resolve. If you never had cataract surgery then eventually you'd have gone blind, so despite the problems you are going through, things would have been worse if you hadn't had the surgery.
The "halo rings" are more likely with a multifocal, though usually only a minority find them problematic, which doesn't improve things of course for those unlucky enough to be a "statistic". Some fraction of people with monofocals get them as well, there isn't an IOL invented yet that doesn't give a small fraction of people problematic halos. Based on data I'd seen unfortunately I suspect the Restor may be more prone to problematic halos than other multifocals (though it isn't clear since I hadn't seen a head to head comparison, merely separate studies which may have asked different questions and not be truly comparable). Although many people who have problems with halos see them disappear in the first few months, with others it can take a year or more, so there is still a chance they will go away. If the issue is too bad, you can consider getting a lens exchange for a monofocal in hopes that will get rid of the issue. However the surgery for that also of course requires incisions which risks making your dry eye issues worse.
The issue of needing a brighter light to read is more common with multifocals since they split the light for different focal points, however even some people with single focus IOLs can need more light to read. I know someone with the Crystalens, which is an accommodating lens, but that still means it is still a single focus like a monofocal. He brought a reading chart to a meeting in a well lighted auditorium and demonstrated that even holding a folder to cast a shadow on the reading chart was enough to reduce his near vision a few lines. In my case that didn't change mine at all, so I don't know how much of the variation depends on people's sensitivity to light or if the lens I got does have better contrast sensitivity. I have the Symfony lens which is "extended depth of focus", neither a monofocal nor a multifocal.
I will note that as people age they need more light to read, but I don't know how much of that is due to aging of other parts of the eye, or how much of that is due to the aging natural lens. If the issue is mostly the lens, its possible that although you need more light now than you used to in order to read, that you'll need less than others your age when you get older.
The "halo rings" are more likely with a multifocal, though usually only a minority find them problematic, which doesn't improve things of course for those unlucky enough to be a "statistic". Some fraction of people with monofocals get them as well, there isn't an IOL invented yet that doesn't give a small fraction of people problematic halos. Based on data I'd seen unfortunately I suspect the Restor may be more prone to problematic halos than other multifocals (though it isn't clear since I hadn't seen a head to head comparison, merely separate studies which may have asked different questions and not be truly comparable). Although many people who have problems with halos see them disappear in the first few months, with others it can take a year or more, so there is still a chance they will go away. If the issue is too bad, you can consider getting a lens exchange for a monofocal in hopes that will get rid of the issue. However the surgery for that also of course requires incisions which risks making your dry eye issues worse.
The issue of needing a brighter light to read is more common with multifocals since they split the light for different focal points, however even some people with single focus IOLs can need more light to read. I know someone with the Crystalens, which is an accommodating lens, but that still means it is still a single focus like a monofocal. He brought a reading chart to a meeting in a well lighted auditorium and demonstrated that even holding a folder to cast a shadow on the reading chart was enough to reduce his near vision a few lines. In my case that didn't change mine at all, so I don't know how much of the variation depends on people's sensitivity to light or if the lens I got does have better contrast sensitivity. I have the Symfony lens which is "extended depth of focus", neither a monofocal nor a multifocal.
I will note that as people age they need more light to read, but I don't know how much of that is due to aging of other parts of the eye, or how much of that is due to the aging natural lens. If the issue is mostly the lens, its possible that although you need more light now than you used to in order to read, that you'll need less than others your age when you get older.
2 Comments
Respectfully, you said the dry eye has nothing to do with the lens? I never ever had dry eye's in my life until the day after the ReSTOR procedure.
Multifocal IOLs are more expensive that monofocals, much more expensive, give lower quality optics, more dysphotopsia, have more surgical complications and higher rates of re-operation than aspherical IOLs. The above posting is not ususual.
JCHMD
JCHMD
re: "Never ever had allergy problems until after the ReSTOR procedure! It has ruined my life!"
As I posted above, there is no reason to believe that anyone has allergy problems due to an IOL. It is possible that the surgery itself led to dry eyes which makes the allergies more bothersome, but that would be true regardless of what lens you had (unless as I noted above there were a lens which could use a smaller incision which might have slightly reduced the risk, but most would use the same size incision).
Although you chose to get the Restor lens even without cataracts, the overwhelming majority of people who get the lens due so due to needing cataract surgery (as did the poster who started this thread) in which case they are risking dry eyes regardless of the lens choice. Personally if I hadn't had cataract surgery I wouldn't have risked clear lens exchange at the current state of the art. (and if I had I'd never have gone for the Restor vs. other options, even 3 years ago, but that is a different debate). Unfortunately there is no perfect lens option, so those with cataracts who need to have surgery need to weigh the risks vs. benefits of each option.
Unfortunately some multifocal lenses do increase the risk of seeing such halos, so it is a risk factor to consider. Even if most people don't find it to be a problem, *someone* does wind up being the statistic who finds it bothersome, so you do need to be prepared for the possibility. Most people however don't find it a problem, especially with newer multifocal lens designs which cut down on the risk of halos quote a bit compared to older ones.
Actually even some people with monofocals see halos, there is no lens invented yet which doesn't leave some people seeing halos after surgery. Some data I've seen suggest Alcon monofocals might even have a higher incidence of halos than the new low add Tecnis multifocals, based on the data online they submitted to the FDA, but since the data is from different studies the data might be misleading (e.g. they may have asked questions differently so the data might not be directly comparable). Even some people with natural lenses without cataract see halos.
A study on the new lowest add Tecnis multifocal showed overall people had a comparable or better experience driving at night with the multifocal than with the Tecnis monofocal. (but some people had problems with each for different reasons).
As I posted above, there is no reason to believe that anyone has allergy problems due to an IOL. It is possible that the surgery itself led to dry eyes which makes the allergies more bothersome, but that would be true regardless of what lens you had (unless as I noted above there were a lens which could use a smaller incision which might have slightly reduced the risk, but most would use the same size incision).
Although you chose to get the Restor lens even without cataracts, the overwhelming majority of people who get the lens due so due to needing cataract surgery (as did the poster who started this thread) in which case they are risking dry eyes regardless of the lens choice. Personally if I hadn't had cataract surgery I wouldn't have risked clear lens exchange at the current state of the art. (and if I had I'd never have gone for the Restor vs. other options, even 3 years ago, but that is a different debate). Unfortunately there is no perfect lens option, so those with cataracts who need to have surgery need to weigh the risks vs. benefits of each option.
Unfortunately some multifocal lenses do increase the risk of seeing such halos, so it is a risk factor to consider. Even if most people don't find it to be a problem, *someone* does wind up being the statistic who finds it bothersome, so you do need to be prepared for the possibility. Most people however don't find it a problem, especially with newer multifocal lens designs which cut down on the risk of halos quote a bit compared to older ones.
Actually even some people with monofocals see halos, there is no lens invented yet which doesn't leave some people seeing halos after surgery. Some data I've seen suggest Alcon monofocals might even have a higher incidence of halos than the new low add Tecnis multifocals, based on the data online they submitted to the FDA, but since the data is from different studies the data might be misleading (e.g. they may have asked questions differently so the data might not be directly comparable). Even some people with natural lenses without cataract see halos.
A study on the new lowest add Tecnis multifocal showed overall people had a comparable or better experience driving at night with the multifocal than with the Tecnis monofocal. (but some people had problems with each for different reasons).
2 Comments
There are comments all over the internet with complaints about these lens.
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