Dangers with Multifocal Lenses

[HH928]

Obviously, any eye surgery will have risks.  I think the risks of implanting a multifocal lens are relatively high.  For example, I had a ReSTOR multifocal lens installed in my left eye and the newly caused blurring never went away after 6 weeks.  The doctor wanted to implant in the other eye within one week, saying that the second eye would improve the first (but now bad) eye. It didn't make sense to me so I got a second opinion. The second doctor said that he will not implant multifocal lenses because the design is not perfected enough to give perfect vision.  He recommends monofocal.  In the multifocus there will be a less clarity that with a monofocal lens because of the design...and you get night vision problems (circles around lights, etc.).  So, I opted to not have any sort of lens implanted in my remaining "good-with=glasses" eye until the first implanted eye clears up. So far, no improvement. In short. I have spent a several thousand dollars on a multifocal lens implant that insurance will not cover and I apparently have blurry vision in that eye that cannot be corrected with glasses, YAG, or anything else. I wish now that I'd had the monofocal lens implanted...or just stayed with spectacles. I'd have been much better off. My day to day quality of my life is now much degraded and there's, apparently, nothing that I can do to regain the vision that I had before the implant.

The doc says that most people (80% or so) are 'satisfied" with the less than perfect multifocal lens implants becasue their use of glasses are minimal afterwards.  Others wish they'd never done it. And I'm permanently worse off.  If you like to gamble, multifocal lenses may be for you.

[Becko1213]

I am experiencing the same problem as a couple of people have noted above. I had a Crystal Lens implemented. Everything is very hazy - it’s like looking through Vaseline. My surgeon performed the YAG laser procedure and said that would clear it up. Well it hasn’t.

What a horrible decision to have ever had this surgery. I have no idea what to do from here other than trying to learn to live with it. It has definitely impacted my life.

All these doctors who push toward Crystal Lens are full of crap.

[JohnHaganMD]

Get a second opinion from a different surgeon. Seek out a cornea/refractive/IOL surgeon that specializes in post-cataract complications. ( Most large communities have one or you can go to the Department of Ophthalmology at a medical school).  Special tests needed are a macular and nerve fiber layer OCT and cornea topography.

[at_239]

Based on my experience my advice is never have a multifocal lens implant. If for some reason you are desperate to be glasses free than do the research first and see a consultant who will warn you of the poor performance of these lenses. If reading is important then never have them. The result makes reading with glasses worse than standard lenses and your life will be ruined. If a consultant promises to make you glasses free then walk away, they are liars. Find a consultant who talks about less dependence on glasses.

[JohnHaganMD]

As I have said before there are some eye surgeons office where from the time you enter they 1. want you to have cataract surgery 2. want to upsell you on things like femtosecond laser, ORA technology, multifocal/accommodating lens implants.  The only 'upgrade" I think is worthwhile for most people is the toric implant for people with larger amounts of astigmatism.

[at_239]

Thanks for repeating that. It cannot be said often enough. It is a pity that your last sentence cannot be made into a banner at the top of the page for anybody visiting this site.

[JohnHaganMD]

Remember the fundamental questions is first: Do you really need a cataract operation. If you are functioning well, don't feel like your eyes are holding your back, if you can drive comfortably at night and would assess your vision as 'no problem' or little problem you don't need cataract surgery. In my neck of the woods one office tries to do cataract surgery or seemingly everyone that comes in for a routine eye exam.

[Jim_in_Italy]

I thought I submitted a comment yesterday but I see it did not post. Forgive me if this turns out to be a duplicate.  While I respect Dr Hagan immensely, and appreciate all the time and effort he takes to educate readers of this website, for which we are all extremely grateful, I do wish to submit a minority opinion. I chose back in 2015 for the Tecnis Symphony toric IOL with -.75 monovision and could not be happier. Admittedly I was highly myopic with above average astigmatism, so ANYTHING would have been an improvement. I don’t know why my experience has been so different from so many others (and count my lucky stars) but perhaps it was 55 years of wearing contact lenses and adjusting to a different correction in each eye, or perhaps it is just the way my brain has accepted multifocal. As an aside, I have met people who  cannot use multifocal eye glasses. I wonder, Dr Hagan, if that could be a differentiator in identifying who might be candidates for multifocal IOLs????  In any event, rather than re-writing what I  thought  I had posted, here is a link to what I posted years back when I was asked about my positive experience.  Again, I realize I may be in the minority but.....it may benefit some who are trying to decide this difficult choice.
https://www.medhelp.org/posts/Eye-Care/my-very-good-experience-with-AMO-Tecnis-Symfony-toric/show/2766693

Thanks again, Dr Hagan

[Jim_in_Italy]

PS: there is no substitute for in-depth research on this website and in ophthalmic journals.  As much as your time permits. I relied heavily years back on posts by SoftwareDeveloper who also felt positive about the Tecnis Symphony and had the operation outside the US, as I did, because it was not yet approved by the FDA.  Needless to say, find a doctor who will give you all the time you need to decide.  It may be one of the most important health decisions you take in your later years. (It was for me.)

[JohnHaganMD]

Even before cataracts develop some people cannot wear multifocal glasses (no line bifocals).  Some people cannot wear bifocals or trifocals. I have people carry 3 pairs of glasses: distance, shopping, reading.   So there is a strong mix and match.  In controlled studies the % of people dissatisfied, having second surgery and unhappy with the cost is always higher is multifocial / accommodating IOLs. There are obviously some people, like you, very happy.

[janlin1]

I had surgery and then a month laTER WAS DUE FOR THE LEFT EYE.  i TRUSTED THE DOCTOR WHEN HE SAID THE BLURRINESS WOULD GO AWAY.  i AM NOW LegLLY BLIND, CAN'T DRIVE OR PERFORM THE DUTIES MY JOB EnTAILS.  I AM TOO YOUNG FOR MEDICARE AND DON'T GET MED. BENEFITS WITH MY RETIREMENT.
i WOULD RECOMMEND STICKING WITH THE OrDINARY LENSES AND WEARING GLASSES IF NECESSARY.  aT LEAST YOU CAN SEE.

[JohnHaganMD]

I would advise you to find the best referral center you can travel to (example  Mayo Clinic, Cleveland Clinic,  Bascom Palmer Eye Institute of U of Miami,  Emory in Atlanta, etc) to get the best opinion about what might be done for your.

[janlin1]

Thank you. De. Hagam.  I have been through the Philaselphia doctors, and I am confident they are great, barring one.  I can't work and therefore finances right now prohibit travel.  However, I am hoping I will be able to follow your advice shortly.

[JohnHaganMD]

Will's Eye Hospital in Philly is world renowned.  U of Penn good also.

[myRiley]

I am facing cataract surgery next week, and am undecided on which lens to get.  The multifocal or monofocal implant? I read good and bad about the multifocal and is it worth the side affects to spend several thousand
dollars for it? who is to know what to do? so uneasy and undecided?
please help me decide, need to know what to weigh out? pros and cons?

[HH928]

Great! I'll check him out!
H2

[Luvtoski]

Hi, I am not sure which specialist you are referring to, but I live near Seattle, (lake Tapps) and just 3 wks. ago had Cataract surgery done at the Pac Med Clinic in Seattle by Dr. Patel.  He is outstanding...outstanding education, bedside manner is awesome, and he is a top notch surgeon.  Believe me, I interviewed 6 local Cataract surgeons as I had previous Retina surgery and needed/wanted the best.  Google him and check him out...I loved him and have great results.
Post any questions you might have and I will be happy to share more.
Good luck.

[HH928]

Does anyone have a recommendation for a good eye doctor in the Seattle or Salt Lake City areas?  I only have one good eye left and I have to minimize my chances of another implant being bad.

[Ray T Oyakawa, MD]

Use the search function.  I do not implant multifocal IOLs (I have implanted over 500 multifocal IOLs).  I preferred monofocal or Crystalens.   The surgeon must be experience with these IOLs and know how to handle all the post operative problems.  A simple test is to have a hard contact lens over refraction to see if the vision improves.  This basically eliminates problems such irregular astigmatism and refractive errors.  Most problems with premium IOLs are residual refractive error (astigmatism and IOL power).  This can be corrected in most cases.

About 95% of patient with multifocal IOLs will be happy if the surgery is perfect.  This means 5% will not adapt even with perfect surgery.  

Dr.

[JodieJ]

Don't let anybody convince you to have a YAG.  If you continue to be dissatisfied with your ReStor vision, the ReStor can be explanted and replaced with a monofocal IOL.  This should be done by a surgeon who is experienced with this procedure.  You could try asking the surgeons you've seen for a referral.  Consider mini-monovision for your second eye.

[Henchick]

I was advised that this implant has many problems and is not yet perfected, so I declined the option after cataract surgery.

[JohnHaganMD]

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