I am in the UK and had my first eye fitted with multifocal 3 years ago which instantly caused halos/glares. Back and forth to the optometrist for 1 year then eventually went for the 2nd eye doing but with a view to discuss the halos/glares with the surgeon first. The surgeon informed me that once the 2nd eye was done it would balance out my eyesight and the halos/glares would disappear - not so! I then had halos/glares in both eyes! This week I finally saw the surgeon again (a different surgeon same Company) who told me I could have an explant but they couldn't guarantee it would stop the halos/glares also it could change the structure of the eye and cause further problems. He said because the halos/glares have been bad from day one it is not the lens that is causing the problem but my brain acknowledging the lens and dealing with the change. He is now suggesting YAG as I have cloudiness particularly in the right eye, and says it could help slightly. To be honest my eye sight too me is fine I just want rid of the halos/glares. I am so unsure of having any more work done to my eyes as I can't possibly deal with anymore problems. Can anyone confirm that there is a possibility it is my brain not being to adjust to the changes. If so I could consider hypnotherapy!!
I'd 2nd the issue of doing due diligence, the medical standards in other countries aren't always going to be the same as the US is on average. That said, *if* you are willing to do the research, the cost difference can sometimes allow you to be treated by a high quality doctor (e.g. some of the best surgeons in Europe) for less than it would cost to see an average surgeon here (or less than the out of pocket costs here if you have a high deductible and would get a premium lens). You can also often get the latest American technology.. that isn't yet approved for use in the US.
I should add that its useful to do "due diligence" even for surgeons in the US since even within the US treatment quality can vary.
I wore progressive lenses for about 25 years. At 64 I decided that I had enough of broken glasses reading in bed. I went for a consult with a very reputable eye laser company here in Toronto. After all the tests, (no blood work) they can only restore my far vision at the cost of $6,000 +. I did some research and found a doctor in India .... made a appointment through their site. To my horror, they knew nothing about it when I got there. Wasted trip, I thought, but then once I got to Calcutta with friends who host me when in India, recommended a clinic. I still did my research, but decided to take their advice. Got an appointment within a couple of days. Family member accompanied me as I do not speak the language. Once I got in to see the doctor, to my great surprise,he was the same one I had researched days earlier.. He personally saw to all the tests hovering over the technicians I had to go through. They sent a nurse to the house to take a blood sample and after all the other tests, he said I was a candidate as I had no diabetes..this is very crucial. I had one eye done and the other two weeks later and a final test two weeks after that. I was 67 at the time. I developed infections after, but that was due to allergies. He advised me every step of the way and at that point I had traveled from one end of the country to the other. I only wore sunglasses while outside, but don't have to anymore, unless the sun glare is bad. I now wear non-tested sunglasses. As of today exactly 2 years later (2016), I am told that I have young eyes by my dentist. I left it at that, but now people recognize the true color of my eyes and think I have color lens....not so...the natural color is now vivid as they are not under thick bifocals anymore. I am ecstatic...I can read in bed, sleep at any angle... the kicker... I now have almost 20/20 vision... and the cost for the best lens made the US...still a fraction of the cost of the $6,000 Canadian with lifetime warranty. I can contact him directly whenever I need to.
Back home to the land of full keyboards. As Softwear Developer says its not that the IOL can't be replaced after a yag capsulotomy. 1. It often is not possible to put the replacement IOL "In the capsular bag" but their are IOLs for "out of the bag"placement and also anterior chamber IOL. The primary problem is that if a yag capsuology has been done there is usually vitreous loss at the time of surgery because the posterior capsule doesn't hold it back. Vitreous loss means a vitrectomy at the time of surgery and increased risk of retinal detachment and cystoid macular edema but the risks are still low.
It's important to remember that these health forums attract UNHAPPY people. the people that have had RESTOR and are happy are not her posting good results. I know there are ophthalmologists and optometrists that have had RESTOR put in their eyes.
Working off iPhone on road yag and mean Spellcheck changes above
Just because you had yah capsulotomy does NOT MESN THEY CAN'T BE REMOVED AND MONOFOCAL IOL PUT IN
A contrary note here:
In 2010, I had cataract surgery for both eyes. My surgeon is an unusally thoughtful person, and after careful assessment of my eyes ("far-sighted," small pupils, very slight astigmatism), he chose the ReStor D1 lens for me.
One day after each surgery, my vision, from 14 inches from my face to infinity, was perfect. I had almost the vision of a kid again, with only the need to wear readers in very low-light situations.
Six years later, this is still true. I got a superb result with these early ReStor lenses.
Let me add my miserable experience to that of the other Restor sufferers. After a year, I still have very bad eye problems, and blink so much that people think I have a tic. I use Hydroeye supplements 4 daily, all sorts of drops, eye lash cleaners, etc, but nothing seems to help. It is impossible to read except with an auxiliary type of light, like my phone flashlight, and mid range acuity is terrible. I am a sculptor and have a lot of difficulty focusing. Of course, I have the halos and glare when driving at night.
My renowned eye doctor in Sarasota Florida pretty much has given up,trying to help and says my problems were all pre existing. He had no problem cashing the $7000 check above the Medicare payments, though.
In my opinion, the Restor lenses are a scam to pad the pockets of the docs who are not content with the normal insurance payments.
I just wish I had the normal mono focal lenses which seem to work for most everyone. Since I had the YAG, I know it is not advisable to take out these lenses, so I will suffer with them the rest of my life.
how did you proceed to get your money back? Did you ask your surgeon or get an attorney? I am having the same problems as you and everyone else on this board
At 4 weeks the lens may not have been healed completely in the capsule, I'd see what they say at the 2 month mark to see if it is lens movement within the capsule or the capsule moving from loose zonules (either from pseudoexfoliation or whatever other reason). If it is loose within the capsule past when it is supposed to have healed, I'm wondering if suturing/gluing would be an option if that movement is the likely cause. You could mention where you live in case anyone has any recommendations for surgeons experienced with dysphotopsias or other issues there.
The lens I mentioned that is physically larger and comes closer to filling the capsule is the WIOL-CF, a premium lens (extended depth of focus/possibly accommodating) which isn't approved in the US yet. Although it is approved in Europe, from what I've read however they are still focused on doing more testing and potentially refining the product more before they start widespread commercialization of it. That suggests being cautious before considering it, which is part of why I hadn't tried to get answers regarding whether it can be used for a lens exchange or needs to be implanted only right after removing the natural lens before the capsule collapses, and whether or not its larger size could potentially have any impact on iris movement (I wonder in retrospect if I'd not have had an issue if I'd gotten that lens to begin with).
One surgeon who sometimes posts on this site, wanlien3, had expressed concerns in email to someone about the design of the lens however since it doesn't have haptics to keep it in place, though he hadn't personally used the lens and was just speculating about concerns (they expect filling the bag to keep it in place). I do see one paper online talking about case reports of 2 people where the lens dislocated, but I don't know what the overall statistics are since other types of lenses can dislocate also.
I've been told IOL position is good. Operated RE distance vision is 20/20, near vision good w/reading lens. Eye health pre- and post-op good. No dry eye, pressure problems, glaucoma, etc. No capsular tear or vitreous loss occurred during/from surgery. Lens jiggle was noted at 4 weeks as was iris fluttering. Eye has been examined before and after dilation. I will ask about pseudoexfoliation at my next appointment but it hasn't been mentioned. I have searched for and read other threads and articles about flickering on the net, seeking answers.
It would seem the surgery was a success but the patient still has a vision problem! From the 1st day, the flickering has been there and there has been no change or improvement. Maybe it's the floppy iris or maybe issues with the zonules. I certainly don't know and the doctors I've seen haven't had definite answers, which is why I turned to this forum with its doctors and knowledgeable participants. I appreciate the responses. I certainly want to take a cautious approach and not make my situation worse. Maybe I should try hypnosis to attempt to speed up neuroadaption!
re: "If only I could know whether there will be any improvement, even it takes months. "
I should add that unfortunately that isn't possible for anyone to predict since each person's case is different, in addition to there being multiple potential causes for the issue. There are a few threads around the net about the "flickering" issue from people whose surgeons are usually stumped. Some of them see the issue resolve in a few weeks, or a few months, others in a year or so, some report still having issues years later. In my case I've seen glacially slow improvement over the 1 year its been since my surgery now, but it has improved, so it is possible it will eventually go away. I may take another stab at trying to find options, perhaps consulting an expert on dysphotopsias. I've just been cautious about risking making things worse if there is a chance I can neuroadapt. There are some cases of things that might be described as flickering that are due to stray light reflections in the eye that are resolved with a 2nd piggy back lens.
re: "plus had read IOL exchanges should be attempted as early as possible"
I suspect part of that may be fear that you will eventually get PCO and need a YAG treatment, since after a YAG the replacement lens usually can't be put into the capsular bag, which is where they prefer to put it. Different lens models are used outside of the bag and there are fewer choices, but it is still possible, even if the risks are a tiny bit higher. A prominent surgeon I had a followup with said that it appeared based on how I was healing that it was unlikely I'd ever get PCO and since the surgical result looked good that I could get a lens exchange at any time in the future if needed, even years later. It could be that a lens exchange would be easier before the capsular bag healed around the lens in the first 6-8 weeks, but you would be past that by the time you got an exchange now.
re: "Ophthalmologist has seen iris "fluttering" and lens "jiggle" in the capsulary bag."
My impression is that usually by 7 weeks the capsular bag should have healed around the lens well enough to keep it from moving , think the guideline I'd read was 6-8 weeks, but perhaps those are merely the usual cases and you are just a low probability outlier and it hasn't yet finished healing to prevent the lens from moving.
The question is whether as the Dr. mentions the issue isn't the lens moving within the bag, but the bag itself jiggling due to the zonules (like ligaments) holding the bag in place being loose. Unfortunately if the zonules are weak, any additional surgery like a lens exchange risks making things worse.
If the zonules are loose, in some cases they suture the lens to another part of the eye to stabilize it, presumably in this case if your iris is moving that would need to be the scleral wall. I have heard that this has risks itself , and again the trauma of surgery might make the zonules worse.
As I've mentioned in my post, my issue seems likely to be from iridodonesis, iris jiggling, but I hadn't been told of any useful approach to consider treating that. There are some larger lenses I've heard of in clinical trials in Europe that may fill the capsular bag more, but I I hadn't tried to get an opinion about whether they might make any difference, or whether its too late after having the smaller lens in the bag for a year now (and I'd read negative comments about the one I was wondering about since it doesn't have regular haptics and so a surgeon was concerned that if it didn't fill the bag well it might move).
I have read that the lens jiggling, psuedophakodonesis (though there are a few variations on the spelling) can be harder to see if the eye has been dilated with drops that are cycloplegic, which most drops they use for dilation are. A cycloplegic is a drug which reduces accommodation and tends to tighten the zonules which may reduce the jiggling. Often eye surgeons see a patient after their eye has been dilated by staff, so you might ask about that if that is what has been done so far. There are non-cycloplegic dilating drops, so perhaps the doctor might consider using them to look at you, or looking at you before your eye has been dilated if he hasn't.
If your refractive error is +0.25 and your eye is healing otherwise normal your vision without glasses should be 20/20 or there abouts. Without glasses or contacts your distance vision should be much better in the operative eye than in the unoperative. Eye you would then have "full monovision" Operated eye for distance unoperated eye without glasses/contacts for near. If your operated eye is not 20/20 at distance (and 20/20 at near with about a +2.50 reading glass) then you would need to have an explanation. Its not at all likely that the minor "flutter and jiggle" you describe (usually due to torn or lax zonules) would create a problem with a yag capsulotomy. You might confirm with the surgeon that you do not have "pseudoexfoliation" a condition that predisposes to lax/weak zonules (and glaucoma) and also that there were no operative complications such as capsular tear or vitreous loss.
JCH MD
Thank you, Dr Hagan. At this time, my vision is not correctable with glasses due to significant differences in unoperated LE and operated RE. I'm wearing a contact lens in LE to achieve vision balance, which gives a version of mini-monovision. I had intended to have non-dominant LE corrected in this manner but have canceled LE surgery as I really couldn't tolerate both eyes flashing at me!
I tend to be a perfectionist and problem-solver type, plus had read IOL exchanges should be attempted as early as possible, so have been seeking a resolution but your more conservative approach might be best. If only I could know whether there will be any improvement, even it takes months.
Another question: since IOL is loose in the capsule, if PCO developed, requiring YAG treatment, could this change IOL position and my vision? Could IOL slip out of the capsule?
First of all your IOL power is fine for distance (20 feet or more) and should give you 20/20 distance vision (if no residual cylinder) plus/minus 0.50 is well within the accepted range of IOL power done pre-operatively. The symptoms you describe (IOL dyphotopsia) normally get better over time (weeks to months). The IOL you have is a high quality and not associated with increased rates of dyphotopsia (such as the ReStor and ReZoom) If IOL is in good position and no other problems and distance vision is good (and near vision with reading lens). Would really think twice before exchanging IOL. Tinted prescription glasses with anti-reflective coating also helps in some cases. JCH MD
I had cataract surgery 7 weeks ago. AcrySof mono focal lens implanted in dominant right eye. Was myopic, -3.25. ORA system used to try to ensure best refractive target (Plano); however, result was slightly hyperoptic (!) (+.25) and light flickering, like bad fluorescent lighting, has plagued me since bandage removed first day postop. Have seen another ophthalmologist and a retina specialist. Ophthalmologist has seen iris "fluttering" and lens "jiggle" in the capsulary bag. BTW, I have dark brown eyes. Focusing on one fixed spot when reading does stop the flickering but flickering also occurs from bright overhead lighting such as at work (lens edge reflection?). I can't imagine living 25 years or so with this constant flickering and want to consider a lens exchange but Dr is concerned whether another lens will fill the capsular bag and/or support the iris any better. Canceled left eye surgery until RE is resolved. I've been following topics and posts, hoping to learn more and maybe find a solution to these problems. Would appreciate comments/advice. Thx
AMEN: everyone that thinks that forking out the extra bucks for a "premium" lens is guaranteed to be happy and glasses free please read the above.
JCH MD
Given all the extra expense of the restor multifocal IOLs, there is total failure to achieve expected outcomes that the glossy advertising propaganda talks about. Just because you pay for a “premium lens" costing thousands of dollars out of pocket, don't expect better outcome. A person can research these lens' but ultimately one relies on their MD's recommendation, and my Dr said I was perfect for them.
My distance vision may be improved by 30%, with the Dr saying I could probably pass the drivers exam (20/40). No way, even if I could fudge the test, would I drive like this! I have at least 50% worse reading vision. Post op I only saw smudgie lines, I've now "improved" to seeing somewhat faded, broken letters.
I wasn't expecting youthful 20/20 vision, but the soft-edged vision is unacceptable. I think I could live with halos, but I have funneling concentric rings at night driving. The literature boasts not having to rely on corrective lens' anymore. Well, without corrective lenses, I would need a dog. I have this come-and-go flickering, like a tuning fork, going on and it's annoying. The Dr frequently harps on there being no guaranty, but is pushing me to have it explanted, before a 6 month time frame. Do I really want to incur more costs, and enter into another post op 'no guaranty' zone? No thanks. I'm lucky I had the fore site to cancel the other eye implant, so at least I have one good eye which is easily corrected with glasses. Don't. Do. It!
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".