ReZoom IOL exchange 11 years out post YAG

[Gmag21]

Hi everyone,

In 2007 I had cataract surgery (age 17) and had a ReZoom multifocal IOL placed in my left eye. From day one I noticed waxy/hazy vision along with annoying halos & glare. Because my right eye is natural I’ve been able to “get by” all these years due to my brain having the ability
to filter out the left eye disturbances.

Fast forward to 2013 and I’m suddenly experiencing double vision in my ReZoom eye along with the same complaints of cloudy/waxy vision. At this point the doctor decides to perform a YAG laser treatment but immediatley afterwards I couldn’t see much of anything (he said the laser wasn’t able to penetrate my eye and as a result particles are now floating around in my vitreous). Less than a week after the YAG we did a vitrectomy surgery to restore my vision. The vitrectomy helped tremendously and the waxy/cloudy vision disappeared. However, ever since we did the YAG/vitrectomy, my halos and glare have become SIGNIFICANTLY worse. Lights over my head now create lots of glare and I now see fog surrounding white text against dark backgrounds. To make things more complicated, my right eye now has a developing cataract and I’ve noticed it starting becoming more dim and my dominance is slow shifting to the ReZoom eye. My theory is that the halos are becoming more noticeable because my natural right eye is not able to filter out the left eye as good as before.

With the above said I’m now considering exchanging my ReZoom multifocal IOL for a Softport AO (monofocal aspheric IOL). I’m scared to do another surgery in this eye but it’s at the point where it interferes with my life every day and I’m only 28 years old with many years left to live (hopefully). Do you guys think for my situation an exchange is worth trying? I went to see Dr Safran in New Jersey and he said he could exchange it for me with 2% risk factor but I’m still a little worried about it.

Also I work on computers for a living so if I did move forward with the exchange I can’t decide if I would prefer distance or intermediate vision for the monofocal. I don’t mind wearing glasses for computer work but it scares me to imagine looking @ my phone and not being able to read anything on the screen. Also with my right eye cataract getting worse I’ll likely be fixing it in the next 1-2 years... Any thoughts or recommendations on the exchange and future right eye IOL would be much appreciated since I’m not sure what to do here.

Grant

[Estasa]

No double vision.  I have negative and positive at different times and in certain lighting situations.  I do not it have all the time.

[JohnHaganMD]

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[Estasa]

Dr. Safran did an exchange for me to the sofport.  He is great!

[JohnHaganMD]

If you are happy with sofport that's great.

[Gmag21]

Really that's awesome! Do you mind if I ask what type of lens you have before and are you now happier with the Softport? Were you post YAG laser before the exchange?

Grant

[Estasa]

The sofport is actually the third IOL that was put in my right eye.  The first was an acrysoft sn60wf and the seceond was the tecnis zcboo.  After the two lenses I was recommended to see Dr. Safran. My main problem was dysphotopsia and Dr. Safran strongly recommended the sofport.  It has a very low refractive index.   Not sure if the dysphotopsia is completely gone but out of the three lenses, it seems to be the best.  Dr. Safran is extremely experience in exchanges.  If anyone can do an exchange after YAG, he would be the one.  I did not have YAG yet.

[Gmag21]

Wow that’s a lot of IOLs!! Glad the Softport is working out for you. Do you mind if I ask what kind of dysphotopsia’s you have with the lens? Do you have any double vision or maybe just some small halos at night?

[JohnHaganMD]

Dyphotopsia is something I've done original research on and is described on my home page blogs:

https://www.medhelp.org/user_journals/index/177275?personal_page_id=67912


https://www.medhelp.org/user_journals/index/177275?page=4&personal_page_id=67912&sort_by=date


https://www.medhelp.org/user_journals/index/177275?page=6&personal_page_id=67912&sort_by=date  ;

[JohnHaganMD]

Please read this article carefully:   https://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You      ; You would be wise not to opt for full monovision as most people can't adjust to it and glasses are generally not comfortable because the strength is so much different in one eye than the other.    We do not use AO SofPort in our practice (We use mostly Tecnis) but that IOL is given high marks in the medical journals. I would get at least one other opinion from a eye surgeon that specializes in post op complications and IOL exchanges.  Know that most cataract surgeons don't have much experience with this because 99.5% of patients do well and IOL exchanges are relatively unusual.  Every community has one surgeon that specializes in taking care of rare post operative complications.

[Gmag21]

Thanks for the article!! Any thoughts on both eyes being set for the same refractive error? I'm thinking about exchanging my rezoom eye for a monofocal set for distance and then shortly after doing the other eye also set for distance. Considering I'm young, work on the computer, and frequently shift from computer screen to keyboard to smartphone, would I be shooting myself in the foot with this? I like the idea of having good uncorrected distance vision & just using glasses for computers/upclose (while I'm at work all day) but I'm still not sure if it makes sense for my somewhat active lifestyle. I wonder with both eyes set for distance if I'd be able to see my family at the dinner table without needing glasses? Decisions decisions...

Thanks again for your help!!

Grant

[JohnHaganMD]

Distance optically is 20ft/6m      The planned post op correction for this is 0.00 refractive error.   Most people are unhappy with this as reading and TV and computer all out of focus.   A better selection for most people  would be "mini-monofocus  distance bias"   Your dominant eye would be 0.00 (some surgeons like to shoot for -0.50) and would be for distance and the non-dominant eye about -1.00 or -1.25 for computer and in very good light even some reading.  My wife chose this. I have not had cataract surgery but I'm myopic and have always read well without glasses. I would choose mini-monofocal near bias. But we are all different (why we choose different types, brands, colors of cars)

[Gmag21]

Very much appreciate your comments once again!! If I went with the "mini-monofocus near bias" is the general recommendation  for your dominant eye to be set for intermediate/computer and the non-dominant for near/reading?

[JohnHaganMD]

Generally dominant eye for distance (or biased in that direction) and non-dominant for near.  There are exceptions and you may be one since your non-operated eye doesn't need surgery in the immediate future.    Do you your present glasses prescription. If so please post.  Also your ReZoom has reading and intermediate and distance RX on it  so it will be totally new experience for you with monofocal IOL which will have only one RX.   Just FYI the ReZoom is almost never used anymore because of the problems you have had. Even when it was new our practice didn't like it and didn't use.  Not that that helps you.  Just FYI for other readers.

[Gmag21]

Currently my non-surgical right eye is -2.0 Sph (no astigmatism) and the left rezoom eye is -0.75 Sph with -0.50 Cyl. My right eye does most of the heavy lifting for near vision so I’ve never needed to wear reading glasses. I can see the computer screen great with my rezoom eye (but again the vision is dominated by halos and glare which drives me nuts).

I’m curious if the FDA still approves use of ReZoom lenses with all the problems it has. Really wish I would’ve got monofocals from the beginning!!

Thanks again

[JohnHaganMD]

I did a very quick internet search and it looks like it is still manufactured. Whether is has been upgraded or changed I don't know.  Your glasses RX now is mini-monofocal   near bias  LE spherical equivalent is -1.00 and RE is -2.00    Must have been a problem with IOL calculations in LE as normally would not leave myopic.  So if without glasses you can read with RE and then targeting about -0.75 to -1.00 for IOL exchange would work well for many people. You half diopter of astigmatism which isn't a lot. Depending on what direction it is might be dimiished by surgery if plus cylinder at 180 and temporal incision.

[Gmag21]

Very interesting! If I were to go with -0.75 to -1.00 for the exchange IOL what would you recommend for the future RE? I think the right eye will likely need to be fixed in 1-2 years (I'm starting to have issues with starbursts and have the classic silhouette problem when people stand in front of windows with sunlight behind it).

Maybe another option is that I hold off on the exchange until my right eye is bad enough that I can treat both eyes back to back (exchange rezoom & then fix RE). That way if I decide to go with a near biased "mini-monovision" setup I could set my dominate right eye for intermediate (as recommended) and the left eye for up close?