Rezoom revisted

[Highsound]

I'm back with an update and question. Brief history. Rezoom inserted in right nondominate eye 2/28 and Crystalens removed from same because of scar tissue displacement which was not corrected by Yag laser capsulotomy in Oct. Left eye is 20/20 with very small stable cataract.
Lens was put in cilliary sulcus. First week results were great with 20/20 far and J3 close and no visual aberrations. Lens started decentering resulting in more prominate ghosts and halos as it got worse. Doctor said he would fix it in place with a stitch and I would get back initial great visual results.
3/6 IOL was repositioned and McCannel suture done to fix to iris.
Initial results were poor with bad ghosts and halos which blurred vision close and far day and night. Over 2mths, vision improved where outdoor in bright light it's excellent but ghosts indoors remain,very bad under flourescents. my brain was freaking out. Doctor said eliminating -.75 in 105 axis astigmatism would make everything much better. Prescripted glasses to help simulate correction. Planned AK in June at 90+ days out. Glasses sharpen images so ghosts and halos are not as disturbing, but do not eliminate them. Close and intermediate no change. I only have sweet spot at 8in. without ghosts.Went to another doc for 2nd opinion. He said lens was centered but slightly tilted and thought it could be causing my problem. Didn't say what to do about it.
Looking for input whether I should ask for another op to attempt tilt removal or try to live with it. Multifocal lens placement seems critical to be success.Guess I fall in the 5% group.

[Forum-OD-MP]

another opinion is never, ever a bad idea.  but repairing a "tilt" will not be easy.  it'll be difficult and unpredicatble.  so the question really is...are the devils you know (ghosting, etc) worse than the unknown?  will another surgery fix your problems?  hard to answer.

[Highsound]

Yes, that's what going through my mind as I struggle to make a decision. So far, nothing has worked out well in the 3 operations during the last 11 mths. I may proceed with the Astigmatic Keratotomy and wait a few more months to see the results. My concern is the IOL may heal into the iris by then and the danger of damaging it during a redo will exist and I'll be in worse shape.
I really would like to know if the slight tilt which even my original doc now sees will prevent the lens from ever achieving anything close to what I once had after the second op.
Both of these docs are well known and supposively top surgeons in the field. Disappointing to me they don't seem to know the answer.

[jamesf]

I am also having trouble with indoor vision after rezoom surgery. I realize it is still too soon to determine anything.  My question is what is your definition of 'ghosting'? I am trying to understand how to describe the blurry vision that I am having inside. I understand exactly what halos are (wish I didn't). I am just trying to clarify between ghosting, glare, blurry and any other terminology being used to describe nonperfect vision.

thanks

[Eagle eyes]

Ghosting usually refers to seeing a shadowy image of the image you are looking at slightly behind or beside it. For example you see the letter E but there is a shadow of an E (like in 3D) beside above or behind it, so to speak.) Usually caused by astigmatism, but can be because of a spherical refraction as well. Can happen with any IOL, but certainly more noticeable and sometimes bothersome with multifocal IOLs. Can be exacerbated with external eye conditions such as dry eyes, scarring, etc.  Halos are usually an extra ring or fuzziness around a point of light and are most always seen at night when looking at a point of light. Glare is debilitating to the point that you have trouble seeing what you are looking at as a result of the halo, starburst, etc. This is usually caused by certain kinds of cataracts. Starburst is usually seen in near-sighted people or those with astigmatism. (linear brightness coming from looking at a point of light, like street light at night. Sunburst/starburse. Can be at any clock hour, depends on where the astigmatism  on the cornea is located as to where the starburst is seen. With multifocals like ReZoom and ReSTOR, as the brain adjusts to the new vision, it learns to ignore all of these "unwanted visual sensations or "UVS" as we call it. People have them naturally before surgery but mostly are not aware of them. After surgery, one notices every little thing. It is like driving a Mercedes. on the road if you own a Mercedes, you notice them everywhere you look. Or if you are pregnant, you notice pregnant women everywhere you look. That is the world in which you live, so it becomes more apparant to you. Hope this helps. Discuss with your surgeon and find out what your refraction is...

[K-D]

Jamesf,  I can so relate to your frustration and concerns.  I had a Rezoom implanted 2/06.  I had the same problem that you describe.  Whenever I would go into a building, my vision completely changed.  My outside vision became spectacular after a time,  and still when I went inside, my vision blurred.  But this is almost 4 months now since the surgery and my vision still improves daily. My inside vision is almost as clear as my outside vision now.  Now I am so happy that I choose the Rezoom and am going to have the other eye done in Sept.  Some people just take longer to focus, I guess.  I don't know how else to explain it.  I have astigmatism so I do have the lively night show.  But for me, my advantages with the Rezoom have become so great, that I can live with it. If I did a lot of night driving, that would be another story.  But hopefully your focus will come around too.  I never thought my would, after two months.  But it has, and continues to get better and better. Wishing the same for you!

[Highsound]

Pilocarpine Hydrochloride 1% eye drops.
Yesterday Doctor gave me a bottle and said use 2 times/day to constrict pupil size. Immediate effect was to almost completely remove ghost images in low light and indoors. Halos and auras around lights also greatly reduced in daytime hours. Haven't seen effect at night yet, since it only lasts about 5 hours. My eye aches for about 45 minutes, like a muscle is over stretching.
Nice to be able to see clearly again indoors if for only part of the day. Vision is dimmer in lowest light with smaller pupil. Very acceptable for opportunity to clearly see indoors again  especially under flourescents. Don't know why I'm on it or for how long. It works for me. Going back in a week for next appt.
  Not sure now if lens tilt is causing my problems. With the drops,I also have decent intermediate vision and can even see close with my reading glasses.  
Those who have not experienced these aberrations cannot appreciate how disturbing they are mentally. Relieved to get rid of them if only for part of the day.
Glad to hear your doing well KD, but, after over 3 months, I am not optimistic that my indoor vision will improve much. Outdoor vision has been great for over a month. I'm thankful for that. Hard to believe the deteriation going inside makes. Eagle Eyes' description of ghosts, etc. is right on.

[K-D]

Highsound, I sure know the mental stress you are experiencing and I am so sorry.
I am not in the eye care field. So, this is just a hunch I have. Since the drops help you, I have hope that time will also help you, because if your aberrations were related to a tilt, I would not think the eye drops would help.  Again, I am not in the eye care field, so only a eye care specialist could give you a correct answer.  But you have had more than one operation, and really have not had time for the eye to settle down.  I am so hoping things will turn around for you. At one time I could only see clearly to arms length.  Now, I see spectacular at distance, intermediate, and good reading, depending on the lighting for reading.  At one time, I was so very upset.  Now I am so pleased.  Some people take longer to heal and focus.  I am hoping that you are one of those people. Best wishes for you Highsound!
Kathy

[K-D]

PS. Highsound, it was after 3 months that my inside vision began to focus. The outside vision was incredible after several weeks.  So, I did not have hope for the inside vision to clear either.  Let your eye heal and settle down.  It was after 3 months that day by day my inside vision became clearer and clearer, and continues to get better. I had no hope of inside clear vision either.  Now it is almost as clear as my outside vision. Hang in there Highsound. I think the reason that it is so upsetting is that most people with Rezoom see clearing immediately.  But not all do.  And that does not mean it will not clear up.  I can testify to that.  Believe me.  I once was a total wreck. Now I am so thankful I choose the Rezoom.  Just give it time. I never thought my vision would change either, but it did!  The brain has to adapt too. And it takes longer for some people. Don't give up!

[jamesf]

Thanks for sharing your experiences. I feel much better hearing that someone has gone through the same indoor vision blurriness and has ended up with great vision. My outdoor vision is spectacular and I am anxious to see it carry over. I know that it takes time for the rezoom to function but it is hard not to panick when your vision is concerened expecially when your next eye surgery approaches. The doctor I went to should have stressed the time factor more. My next surgery is scheduled for Thursday and I am feeling much more relaxed about it now.
I am so glad there are forums like these to turn to. No manufacturer's websites come close to giving people the truth about the day to day coping with the aftermath of cataract surgery. If any of these manufacturer's had any gutts (rezoom, for example), they would have their own forums for people to read, ask questions and talk to other rezoom patients. I'm sure the feel that they would risk scaring off future customers, but in reality they would be doing themselves a favor.

[K-D]

Jamesf,

I am so glad that you feel better.  Believe me I know exactly how you feel. I was so upset when I could only see to arms length, "inside", after my surgery. I cannot believe how it has improved, when I had no hope for clear inside vision.  When I would go into a store, my heart would drop, because I went from clear vision, to total blur.  Now I go into stores and forget that I went from outside to inside. And the Rezoom is made for bilateral implant so that is a plus for you too.  I will have my second implant in September. I am wishing the best for you James. Believe me I have been there, and it is not a nice place to be.  Let us know how you are doing. And keep in mind that my inside vision did not clear until starting the 3rd month and continues to improve.  Best of wishes for you!!

[Flydoc]

I don't think I have read about any pilots that have had the ReZoom lens implant.  I am a 45 year old strongly myopic amateur pilot and a veterinarian and have cataracts in my right eye and to a lesser extent in my left eye.  The ophthalmologist I currently see only does the Restor lens and monofocal lens.  I think that I would prefer the purported better distance vision and intermediate vision of the ReZoom from what I have read.  Does any one know any pilots that have had the ReZoom lens implants and if so what are their experiences?  I do not do much night flying.  The doctor I see now thinks the monofocal lenses offer greater clarity, but I would need to wear glasses for near and perhaps intermediate vision. To fly, I must have 20/40 near and distance vision(corrected or uncorrected)

[Eagle eyes]

I know of several differnet ophthalmic colleagues that have patients with MF IOLs. IF you would like to commumicate off-line, give me your email address and I will contact you for further details.

[Flydoc]

I would greatly appreciate any advice you could give me.  How should I contact you directly to give you my email address?  Flydoc

[Flydoc]

If you have the time, you can email me directly at ***@****  with any information you have about lens implants and multifocal implants in particular. Thank you-Flydoc

[ICanSee]

Jamesf and those who responded... I posted on another thread last week. I had my left eye done with ReZoom last Monday. I started at 20/750 and went to 20/30. My near and intermediate vision are great inside or out. My distance vision is great outside also. But I too am seeing exactly the same thing as you inside - the distance vision is extremely blurry and it is hard to see clearly more than a few feet. I also have the same problem driving at night, which has me worried because I'm supposed to be getting my right eye done the end of July. Currently I can only see at night because of the contact lens I an wearing in my right eye. For those who had/have the blurry distance vision inside, did it affect your driving at night also? This was not something I had ever heard of as a risk with ReZoom. My halos are relatively small and manageable. Everything else is spectacular. Thanks for any feedback.

[stavrocis]

I facing a cataract lense replacement next month and must choose between a ReZoom and a single focus implant.  My research has only confused me more and I need help deciding. My doctor strongly recommends ReZoom (of course he stands to make $7,000 on it, whereas insurance covers the single focus lense.

One optometrist told me that the single focus gives sharper vision (I am a golf and target shooter) and there is less likelihood of something going wrong.  While it would be nice to not need glasses, I wonder if the multi-focus lense is a compromise of finer accuity for the convenience of not needing glasses.
Any advice. (I see from comments here that many had initial problems with ReZoom that cleared up and many describe their vision as "spectacular". That is a tempting result to me.
Thanks.

[Eagle eyes]

If you are 20/750...then you must be near-sighted. Find out what your "refraction" is and make sure it is double checked and IOL selection is carefully considered before the 2nd eye.

[Eagle eyes]

Everything in life is a trade-off.  It all depends on how important being less dependent on glasses is to YOU. If it is a big deal and you are willing to put up with halos described all over this forum, then go for it. If not, then go with aspheric IOL like Tecnis. Have you always worn glasses?

[stavrocis]

To Eagleeyes
Thanks for the response. I guess you are right. I am getting into the paralysis of analysis. On the one hand I am a big reader (professor of law and author) on the other, I am active. A skier, shooter, etc. where mid-randge distance is important.  Now, I am reading articles about using two different IOLs, e.g., ReStor and ReZoom where allegedly you get the best of all worlds, and I realize that is a compromise of sorts.
My father favors the monofocus lense and reading glasses as more of a sure thing. But I fear that I will not have the intermediate distance I need.
I am not looking for a magic bullet, just trying to learn from you folks who have more knowledge and experience.
Thanks.

[K-D]

I know the confusion you are feeling.  And it seems the more a person reads about the different IOLs, the more confusion results.  
Speaking for myself, I had no idea about all the choices in IOLs, until I went to see my doctor.  As I have said before, if I could see fine, except to wear glasses to read, I would have gone with the traditional lens.  But I was told that things would not be clear to arms length, with a traditional lens. And that really was a huge concern for me.  I was informed about the halos at night that might result from the multifocal implant.  But because of my astigmatisn, I also have large circles with spokes in them around anything that reflects at night. Example, a flame from a candle has a very large circle around it, with spokes in it.  Yet, some people get no abberations at all, I am told.  Anyway, I had the Rezoom implanted, thus far, in one eye only.  I was initially very disappointed.  In fact, I wanted it removed, but decided against it. And to my complete surprise, my outside vision became spectacular.  My immediate, inside or outside vision was always excellent.  My reading is very good in lower light, not in bright light. My inside distant vision was good initially only to arms lenght. And now that is very good too. It took 3 months to come around for distant inside vision. Still not as good as outside, but very satisfactory. I don't want to encourage or discourage anyone on any lens.  I am just trying to share my experience with those who are seeking information from those of us that have been through it.   The bottom line to me is, there is nothing as good as God has created. And so all we can do is try to get as close as we can to His perfection.  And for me, I am very satisfied with my Rezoom lens,  (Night only) halos, some glare,  circles and all.  Hope this helps you Stavrocis.

[Eagle eyes]

K-D: I will bet your pupils get rather small when you are outside in bright light. Stavrocis: it would be important to know what size your pupils are in bright light (high noon sunny day outside) dim light (restaurant on Saturday night) and country road pitch dark). This would be helpful info on knowing whether or not to mix ReSTOR and ReZoom. If your pupils are 2 mm in bright light, then mixing might be a good choice. If pupils are 3.5 - 5 mm in bright light then ReZoom both eyes should do it for comfortable reading. If you need fine print like medicine bottle, then again mixing might be best.
It would be great if you could see an ophthalmologist who does both. This is best way to get experienced MD to give you best recommendation. With the intermediate vision and outdoor activities you enjoy, ReZoom in one eye for sure sounds best, not ReSTOR in both eyes. Maybe one of each. If so, have ReZoom in dominant eye

[stavrocis]

Thanks Eagleeyes.  I will bring this up with my Opthalmologist.  I found this forum so useful, especially the citations to other articles on the web. The article about "Mix and Match" IOL were very informative and I found a study that was great from ASCRS San Francisco show supplement.
I have also read the sad stories about serious problems in IOL replacement. I guess you've got to keep your fingers crossed and make a choice.
One last thing, only my right eye has a cataract, my left is 20/425. My big question is that my MD says that I must have both eyes done and that neither a contact lense nor glasses will work on my left eye once the multifocus IOL (like ReZoom) is implanted. Can't I use a multifocus contact lense in my left eye until it really needs surgery?
THanks, it appears you help a lot of people on this. That's great!

[cataract49]

I also had one eye with a cataract that was far worse than the other. I had the ReZoom inserted into my non dominant eye in Jan 06 and have been using a multifocal contact in the other (-5.5) eye ever since. I have no issues and plan to wait until my other eye gets much worse before proceeding with the second eye. I do plan to have a ReZoom inserted when the time comes as I have had a great experience with the ReZoom IOL. From experience, I can tell you that glasses (one lens removed) do not work well.  

From a proceedure perspective,I wear my contact during all waking hours. I had been (and still am) a very successful contact wearer for over 30 ytears.

Good luck!

[Eagle eyes]

Yes try a CL if you like. YOu will know if you can do well with it or not. No reason why you should not be able to if you have successfully worn breviously!
Thanks for your kindness. Best of Luck!