PROBLEM WITH RESTOR

[alicia606]

I have a very strange problem with my Restor IOL and am not sure that it is because of the Restor lense.  I had the surgery a little over 3 weeks ago.  The following day my eyesight was 20/25 and for a few days my eyesight was great in that eye.  Then the eye became quite blurry.  The strange thing is that when I wake up in the morning, my eyesight in that eye is good and I can read all the small print on the TV shows.  Shortly after I get up, however, the blurriness starts and seems to get even worse as the day wears on.  If I put in drops to moisturize the eye, I can see again, but only for seconds.  In that eye near vision is pretty good and that eye is doing great working on the computer where my unoperated eye has difficulty close up and on the computer.

My doctor was puzzled when I first complained of this and when my vision was tested in the afternoon on my second post-op visit.  He had me come back very early the following morning and my vision was better, but still not good.  

To complicate matters, I have normal tension glaucoma.  On the day when my eyesight was very bad at the doctor's office, my pressure was also high (20, which is high for me).  The following morning, it was 14.  Given that, the doctor thinks it is because of the higher pressure.  But that explanation doesn't make sense in light of the fact that the vision clears up when I put the drops in my eyes.  I thought it might be dry eyes, but my eye doesn't feel gritty or dry.

I'm very, very frustrated.  Anybody have anything like this or have a clue what may be causing my vision to fluctuate so much 3 weeks after the surgery when I had excellent vision the day after the surgery?

[rubyrochel]

I've had Lasor surgeory w/ astigmatism correction 3-1/2 mo ago using ReStor lenses in both eyes.  I can see great both near & far, but the light glare (even the slightest day or night) is terrible.  I can hardly keep my eyes opened.  When I try to read I can see print but the whiteness off the paper makes me have to squint. Very stressful.  My eyes feel like I've been out in a speed boat w/o any protection for 3-4 days straight, I've  or been crying for several days.  Eyes feel unnatural and sometimes burn & hurt.  I have good pressure and 20/20 or 20/25 vision.  Dr(s) say I have dry eyes, but i have tried 5-6 different suggested drops and they seem to go from 'not helping to making feeling worse'.  Tylenol helps the pain.  So now am just using saline solution (which is not doing anything other than keeping my eyes clean), using warm compresses and taking fish oil pills.  I must wait another month to see IF fish oil makes a difference.  .. I'm ready to scream!  Next suggestion is to put in tear duct plugs.  Great if they work can't hurt if they don't.

[rubyrochel]

I've had Lasor surgeory w/ astigmatism correction 3-1/2 mo ago using ReStor lenses in both eyes.  I can see great both near & far, but the light glare (even the slightest day or night) is terrible.  I can hardly keep my eyes opened.  When I try to read I can see print but the whiteness off the paper makes me have to squint. Very stressful.  My eyes feel like I've been out in a speed boat w/o any protection for 3-4 days straight, I've  or been crying for several days.  Eyes feel unnatural and sometimes burn & hurt.  I have good pressure and 20/20 or 20/25 vision.  Dr(s) say I have dry eyes, but i have tried 5-6 different suggested drops and they seem to go from 'not helping to making feeling worse'.  Tylenol helps the pain.  So now am just using saline solution (which is not doing anything other than keeping my eyes clean), using warm compresses and taking fish oil pills.  I must wait another month to see IF fish oil makes a difference.  .. I'm ready to scream!  Next suggestion is to put in tear duct plugs.  Great if they work can't hurt if they don't.

[triplevision]

Good day Dr. Hagan, I had Restor implants in both eyes on 9/22/10.  I had had LASIK about ten years ago which was great for about two years and then I started needing reading glasses and then bifocals and eventually trifocals.  I spend the day typing contracts and doing spreadsheets.  After surgery I have 20/20 vision but it's very blurry.  With my left eye I see a triple line of print with shadows above and below the actual print.  With my right eye I see a double row of print.  My DR measured my pupil after the fact and found that my pupils are wider that the center ring of the Restor so me put me on Pilocarpine 1% 4x daily to restrict the pupil.  This reduces the triple print to a readable line that looks like a gray highlighter marked over it. The Pilocarpine gives me a brow ache, makes my eyes quiver, and feel like they are being squeezed.  This feeling of muscle restriction runs down into  my cheek and around the left side of my head where I have a plate from a child hood accident and make me feel like I am on the verge of a seizure for which I take dilantin  It also reduces the amount of ambient light by about 40%and makes me feel like I am always squinting.. He wants me to use these drops for two weeks.  He says I will get uses to it and will  not notice these sensations.  He also said there is an ointment that I could use at night in place of the Pilocarpine but I do not yet know what it is and what it's side effects might be.To me this is not an acceptable long term salutation. I do not doubt my drs. ability -  I just think that this is not the right lens for me. He has suggested Yag, lens exchange or just getting use to this.  He is no longer recommending any one procedure, he want's it to be my decision.  My inclination at this point is to exchange the Restor in my left eye for a mono-focal lens and keep the Restor in the right; possibly do a YAG to clear it up. If I have to ware reading glasses  - so what? - I had better uncorrected far vision before this whole fiasco.  I would greatly appreciate some feedback  from you and anyone who has exchanged a Restor for Mono-focal lens. Because my near, med range and far vision is now 20/20 but blurry I do not know if I should leave well enough alone - thank you for your time. Sz

[alicia606]

Looks like we are in the same boat even though my symptoms are a little different than yours.  My main complaint is the distance vision.  For some reason I can see the computer very clearly with that eye.  Anything beyond that is blurry.  I, too have, halos at night but I was expecting that.  Certainly not expecting this waxy vision.  From my reading, this is something that happens occasionally with the ReStor lens in particular.  It's 4 weeks today and I see no signs of improvement.  I see the doctor tomorrow and I'm bringing up the possibility of having it explanted in the near future.

If you are thinking of maybe having the lenses explanted, don't be quick to get YAG laser done on it because from my research, it may complicate removal of the lens.

Good luck.  There are some posters who said it improved with time, but yet others have to have them explanted and almost immediately notice an improvement with a mono-focal lens.  

I thought cataract surgery was so successful and such a breeze that it is such a shock to be having these problems.  I could kick myself for being so trusting and not doing my research beforehand.  All these problems and the extra money it cost makes me sick thinking about it.      

[blurr]

Hello Alicia, I too had Restor lenses put in 3 weeks ago and I too believed I would have better vision afterwards.
My post-op test results were 20/20 and 20/25. I thought that was awesome! Then one week later they were 20/25 and 20/30. At the 2 week mark 20/40 and 20/50. My sight is progressively getting worse.
Reading and working at the computer is very difficult and I'm getting lots of headaches. Near and intermediate vision is terrible, really blurry with ghosting and double vision. Night time is horrible and makes driving quite scarry. My distance isn't too bad but not completely clear and in no way as good as it was before with glasses. I'm also having trouble with bright light and glare in the daytime and need to wear sunglasses even on the cloudy days.
I'm to be tested again and see my surgeon this afternoon. I really hope he will have a solution for me even it if it means removal of these Restor lenses and implanting another type. I've been reading about monovision and will ask him if I would be a good candidate.
My biggest concern is what if the next ones aren't right for me either?
All I wanted was to be free of my progressives.
It's been a 3 week struggle for me too. Hopefully we will both get this resolved soon and be seeing clearly again. Good luck.

[ace399]

I think I was on the steroid for 3 weeks.

[alicia606]

Hi JodieJ,

I'm pretty sure  he said that or maybe I'm confused and it was someone in his office.  What bothers me is that he never once told me anything about possible blurriness.  If I thought there were more problems with this Restor other than halos at night, I don't think I would've ever gotten them.  He was quick to say that the problems I'm having isn't because of the Restor.  I find it hard to believe that no one else has complained to him of this waxy vision with the Restor.   He's been putting in multifocals for a while; I remember one of his technicians telling me some years ago how pleased she was with her multifocal.  He told me he had put in quite a few Restor lenses and only two complained about  halos.  He seems very confident in his abilities as a cataract surgeon.  I've been going to have for about 17 years so I thought he would put in the best lens for me.  Not sure what to think any longer.

Thank you for your feedback and advice.  I will consider the monovision if this doesn't improve soon.  I see absolutely no signs of improvement in the three weeks I've been struggling with this.

[alicia606]

I'm thinking of getting a second opinion.  Just not sure how to find the best doctor. I live in South Florida so am close to Bascom Palmer, though after my experience going there to a glaucoma specialist, I'm not too keen on getting involved with their whole process.  I went to Wills for a glaucoma second opinion last year and I was happy with that doctor but, unfortunately, she's a little too far for regular care.

I should've considered the monovision option though it wasn't presented to me as an option.  Right now my vision in that eye is at least as bad as when I had the cataract (even with the cataract, I was able to read fairly well with that eye unlike my other eye with which I can't see read anything without readers).

I'm thinking getting the Restor explanted may be a good idea because I've been told that they work best when both eyes are done, and at this point, I just want to leave my other eye alone since I can see fine with that eye if I wear a contact.  Though being almost 59, I suspect the very small cataract in that eye will present a problem in the near future.  I'm soured on the whole deal.  I went in thinking that this is such a safe and effective surgery and am shocked to have complications.  I take a good part of the blame for being so trusting and not doing my homework.  When will I learn?  

Btw, how long were you on the steroids?  I was on them until a few days ago.  I was supposed to take them for another week but he allowed me to wean off them a little sooner.    

[ace399]

My Dr. was trained at Jefferson and did his residency at Wills Eye.  He also performs surgery at Wills.  But, it is still a good idea to get a 2nd opinion when required.  I did when he recommended I go with Restor in my left eye after the Crystalens wasn't working out so well in my right.

I think my Dr. is very good, but he lacks the experience of Dr. O (on this forum) when it comes to how to get the most out of a Crystalens, so it can work for the patient.  My Dr. allowed me to start exercising (workbook) my eye right away, which I think was a mistake.

I am a 63 year old male with -6.50D myopia and my vision was not that good and became uncorrectible with glasses prior to surgery due to the cataracts.  I had to change my tennis game to accommodate.  I'm not a very patient person, but I decided that I really wanted this to work out, so I've waited and put up with the poor vision and continued to learn from others on this forum.

The explant surgery is not much different than the original surgery, if your surgeon is skilled.  It does take longer, but the drops are the same and you use them for the same amount of time.  It is important to wean off of the steroid drops as soon as possible.  My Dr. says it takes at least 5 weeks for complete healing after surgery.  I think the extra surgery to my right eye required an even longer healing time.

In your case, I would definitely get a 2nd opinion, someone who has a lot of experience with Restor IOL's.  Check the location of the IOL to see if he hit target.  Measure the power of the lens to see if he chose the correct power for you.

[JodieJ]

Your doctor's statement that "whatever vision you have at 3 weeks is the vision you'll have" does NOT apply to a multifocal IOL like ReStor. (Did he really say such a thing?)  It makes me wonder about his experience with ReStor.

It's only my non-professional opinion, but I don't think that your past use of monovision has anything to do with your current ReStor issues.  If you were successful with monovision in the past, you should consider this type of correction if you do go for an explant.  Dr. Hagan recently cited a study which showed that monovision provides better near vision than multifocals.

[alicia606]

Hi Ace,

Your advice has been very helpful, especially about the pupil size.  I will definitely ask about it on Thursday when I see the doctor.

You've been through a lot with your eyes.  One can certainly understand your frustration having to wait this many months for clearer vision.  You must be more patient than I am.  What concerns me also is that my doctor said that whatever vision you have at 3 weeks is the vision you'll have.  He's been my doctor since the early 90s, has trained at Wills and John Hopkins and does a lot of cataract surgeries so I thought I was in good hands.  Now I'm not as sure.

My doctor hasn't even brought up the issue of adaptation other than adaptation to glare and halos.  This eye I'm having a problem with is my nondominant eye and had been under corrected for distance when I wore contacts so as to give me some reading vision.  I discovered the cataract in the eye last year when I decided to forego the monovision and my vision in that eye couldn't be improved beyond 20/40, 20/50.  I wonder if all those years of that eye being used for reading is contributing to adjustment problems now.
    
How was the explant after 5 months?  Was it much worse than the original cataract surgery?  And how long after the explant did you have to take steroid drops?  I am nervous about the consequences of the steroid drops which can raise pressure given that I have glaucoma.

Good luck to you...hope you achieve that 20/20 vision you desire in both eyes.

[ace399]

I had my Crystalens explanted from my right eye and replaced with the Restor after about 5 months.  My Dr. cut the haptics of the Crystalens and then cut the lens itself to remove it.

Ask your Dr. about the effects of pupil size and how the Restor adjusts to a smaller pupil.  Also ask if there are eye drops that can help during the adaptation period.

[alicia606]

Thanks, Ace and Dr. Hagan.  I do plan to give it a little more time.  Dr. Hagan,  how much time after IOL placement does explanting become more difficult to perform?  I'd like to do that sooner rather than wait until it's a more difficult procedure.  

Ace, it's interesting that you mention that the dilation of the pupil may've been the reason for the good eyesight for the three days after surgery.  I wonder if my pupil is more dilated in the morning also and that may account for the better vision when I first wake up and watch TV for about an hour.  Looking at my pupil during the day, I think it's quite small.  I'll have to question my surgeon about that.

[ace399]

I have two Restor IOL's and it has been over 3 months since surgery and my right lens is still improving in vision clarity.

If you had dry eyes, you would have them all day long and it can get very painful.  In my case, only Restasis has helped and it really works.

I think each person adapts differently to Restor lenses because it creates a near and far image and your brain sorts them out.  So neural adaptation may vary from person to person.  I've read that it can take 6 months for full adaptation.  I wonder if the good vision you experienced right after surgery is related to the dilation of the pupil from the surgery.  Mine took 3 days to return to normal.

I would give it some more time to see if you will adapt.  My Dr. feels that everyone eventually adapts, but some may have more difficulty during the adaptation period.

I was getting very frustrated with the poor vision in my right eye at all distances, until now.  Next week will mark 4 months since my right eye surgery and finally I am getting better vision in this eye.  If it sharpens up a little bit more, it will have been really worth it.

[John C Hagan III, MD, FACS, FAAO]

The solution that seems the most common if you and the surgeon don't work things out over the next 3-6 weeks is to get an independent second opinion

JCH MD

[alicia606]

Thank you for the response Dr. Hagan.  I've read some of the accounts and problems with multifocals but they didn't exactly mirror mine.  There were a couple that resolved after some weeks and I'm hoping that mine will as well...though with each passing day, I get more doubtful and the doctor doesn't tell me that others have had such problems

The doctor was quick to tell me that it wasn't the Restor that is causing the problem, even before I voiced any suspicions about it.  Of course, before the surgery he told me that he had put in a lot of Restor lenses and only two were unhappy because of the halos.  But even those two decided the halos were preferable to not being able to read close up with a regular lense.  He didn't say anything about blurry vision and now makes me feel that I'm some sort of odd case.  The first words out of his mouth were "bizarre."  At this point, I wish I'd gotten the normal lense and saved myself $2,500.  

It's frustrating to wait such a long time for a possible resolution to the problem which may never come without additional surgery.

[John C Hagan III, MD, FACS, FAAO]

your problems are not unique and have been discussed here many times. You can access those discussions using the search feature and the archives

JCHMD